Outcomes of anatomic total shoulder arthroplasty in B2 versus B3 glenoid morphology: A systematic review

Glenohumeral osteoarthritis (GHOA) with Walch B2 or B3 glenoid morphology poses challenges during anatomic total shoulder arthroplasty (aTSA) due to posterior wear and retroversion. While B2 glenoids are well studied, outcomes for B3 glenoids remain unclear. This systematic review compared aTSA outcomes between B2 and B3 glenoids.

Following PRISMA guidelines, PubMed, Embase, and Cochrane CENTRAL were searched through March 2025 for studies comparing aTSA outcomes in B2 versus B3 glenoids. Extracted data included demographics, patient-reported outcome measures (PROMs), range of motion (ROM), and radiographic findings. Risk of bias was assessed using JBI Critical Appraisal Tools.

Six studies (443 patients; B2 = 290, B3 = 153) were included. Both groups showed significant postoperative improvement in PROMs and pain. ROM improved in both, though gains in flexion and abduction were nonsignificant for B3 glenoids. Internal rotation improved more in B3 glenoids with stepped augmented components. Radiographically, both showed correction of version and inclination, but B3 glenoids remained more medialized. Radiolucency was more frequent in B2 (31%) than B3 (22%) glenoids.

aTSA is associated with meaningful functional and radiographic improvement in both B2 and B3 glenoids. While improvements are observed across deformity types, direct comparisons between B2 and B3 outcomes are limited, and persistent joint line medialization in B3 glenoids highlights the ongoing challenges of managing more severe deformity.