JSES - 2026-06-17 - Journal Article
B2 and B3 glenoid osteoarthirtis: outcomes of corrective and concentric (C2) reaming of the glenoid combined with pyrocarbon hemiarthroplasty.
Ranieri R, Cointat C, Lacouture-Suarez JD, Boileau P
Topics
Key Takeaway
Pyrocarbon hemiarthroplasty with C2 corrective glenoid reaming for B2/B3 osteoarthritis achieved 95% prosthesis survival at mean 4.5 years with no revisions for painful glenoid erosion and adjusted Constant Score improvement from 43% to 97%.
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Summary
This study evaluated whether C2 corrective and concentric glenoid reaming combined with pyrocarbon hemiarthroplasty could address posterior humeral subluxation and reduce painful glenoid erosion in young, active patients with Walch B2 (n=30) and B3 (n=11) glenoid osteoarthritis. Mean glenoid retroversion decreased from 17.1° to 8.3° and posterior humeral subluxation from 74% to 56.5% (scapular plane), with humeral head recentering achieved in 97% by glenoid surface measurement. Prosthesis survival was 95% at mean 4.5 years, with no revisions for glenoid erosion, and all patients returned to sports.
Key Limitation
Mean follow-up of 4.5 years is insufficient to determine whether the 1.7 mm of erosion-related medialization observed will accelerate beyond the reaming-related medialization threshold and ultimately produce the painful glenoid erosion this technique aims to prevent.
Original Abstract
BACKGROUND
Posterior humeral subluxation (PHS) in B2 and B3 glenoid is a cause of asymmetric long-term stress on the glenoid and the potential reason for glenoid loosening in anatomic total shoulder arthroplasty and painful glenoid erosion in hemiarthroplasty with metallic heads. We hypothesized that corrective and concentric (C2) reaming of the glenoid associated with pyrocarbon hemiarthroplasty (HA-PYC) could improve the centering of the humeral head and decrease the risk of persistent painful glenoid erosion in young and active patients with B2 and B3 glenoid.
METHODS
Between 2014 and 2020, 41shoulders (in 35 patients, mean age of 57.9 years) underwent HA-PYC combined with C2 reaming for B2 (n = 30) or B3 (n = 11) osteoarthritis. Patients were prospectively followed with computed tomography (CT) scans performed preoperatively, immediate postoperatively, and at last follow-up (>2 years). The primary outcomes were 3D-corrected CT scan measurements of glenoid version, PHS, and progression of glenoid erosion. Secondary outcomes included functional outcome scores, return to activities, and revision rate and complications.
RESULTS
At a mean follow-up of 4.5 years (2-9.5 years), the prosthesis survival was 95% (39 of 41). No patient has been reoperated for painful glenoid erosion. The mean glenoid retroversion decreased from 17.1° ± 7.5° preoperatively to 8.3° ± 8.2° at last follow-up (P = .001), and the mean PHS from 74% to 56.5% (P = .001) based on the scapular plane and from 59.9% to 50.3% based on the glenoid plane. The humeral head was recentered in 97% according to the glenoid surface and 71% according to the scapular plane. Correction of PHS in the scapular plane was highly correlated to correction of glenoid retroversion (P < .001). CT scan measurements showed that the average total medialization was 3.7 ± 3.2 mm (2.0 ± 1.8 mm due to reaming and only 1.7 ± 2.4 mm due to erosion). The adjusted Constant Score increased from 43% ± 13% to 97% ± 16% and the Subjective Shoulder Value from 38% ± 14% to 84% ± 12% (P < .001). Overall, 84% of active patients returned to work, and all patients returned to sports.
CONCLUSION
In B2 and B3 glenoid arthritis, corrective, concentric glenoid reaming combined with HA-PYC improves centering of the humeral head and shows a low risk of painful glenoid erosion at midterm follow-up. The combined procedure results in excellent functional outcomes and high prosthesis survivorship at midterm follow-up. HA-PYC and C2 reaming of the glenoid is an alternative shoulder arthroplasty for young/active patients with type B glenoid osteoarthritis who want to return to work or sports practice.