Management of the Biconcave (B2) Glenoid in Shoulder Arthroplasty: Technical Considerations

Reconstruction of the biconcave (B2) glenoid presents a challenging clinical problem that has been associated with poor clinical outcomes and implant survivorship. The high failure rate from glenoid component loosening and subsequent premature implant failure can be substantially decreased with accurate glenoid component positioning and appropriate correction of the pathologic glenoid retroversion. Careful preoperative planning is essential for accurate preparation and execution of the optimal surgical plan. There are many surgical strategies to address the B2 glenoid, but no consensus on the optimal method exists, as the technique should be uniquely customized to the individual's pathology and surgeon preference. Cases with mild deformity may be corrected with eccentric reaming and total shoulder arthroplasty, while the more severe deformities may require posterior glenoid bone grafting, and/or augmented implants to restore native version. Finally, the reverse shoulder arthroplasty is a reliable option to restore stability and address bone deficiency for the severe B2 glenoid in an older, lower demand patient.