The B2 glenoid: evaluation and treatment

The B2 glenoid challenges the shoulder arthroplasty surgeon who must correct the substantial deformity to provide a well-functioning and lasting anatomic total shoulder arthroplasty. Careful evaluation of the B2 glenoid using 3-dimensional computed tomography imaging provides the most accurate information about the deformity to help guide the surgeon. Multiple surgical techniques and implant types can be used to correct the B2 glenoid deformity and achieve adequate support of the glenoid implant to prevent loosening and failure. Eccentric reaming can correct milder deformities, and posterior bone grafting and posterior augmented implants may allow for correction of larger deformities while still achieving good clinical outcomes. The recently developed zoned conformity glenoid may provide correction of glenoid retroversion and humeral head subluxation while achieving more stable fixation in the eroded glenoid vault. Finally, reverse shoulder arthroplasty is an option for the severe B2 glenoid. Despite the challenges of the B2 glenoid, good outcomes can be achieved with careful planning and the utilization of appropriate techniques.