JSES - 2026-08-13 - Journal Article
Anatomic Total Shoulder Arthroplasty with the Tornier Perform Posterior Augmented Glenoid versus Reverse Total Shoulder Arthroplasty for the Treatment of Walch B2 and B3 Glenoids: A Propensity Score Matched Analysis.
Harkin W, Shen A, Hussain ZB, Hyeamang LJ, Kurowicki J, Lew R, Kerzner B, Hummel A, Hornung A, Lorentz S, Therien AD, Yanke AB, Verma NN, Cole BJ, Klifto CS, Nicholson GP, Garrigues GE
Topics
Key Takeaway
In propensity score-matched patients with Walch B2/B3 glenoids, aTSA with a posterior augmented glenoid and rTSA yield equivalent 2-year PROMs (ASES 87.8 vs 88.6, p=0.79), but aTSA produces greater external rotation (47.7° vs 39.3°, p<0.001) and higher radiolucency rates (41.9% vs 9.3%, p<0.001).
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Summary
This retrospective matched cohort study compared aTSA with the Tornier Perform posterior augmented glenoid to rTSA in patients with GHOA and Walch B2/B3 glenoid deformity and intact rotator cuff. After propensity score matching for age, sex, and retroversion, both groups achieved equivalent ASES, SANE, VAS pain, and MCID attainment rates at minimum 2-year follow-up. aTSA provided superior external rotation (+8.4°) and forward flexion (+13.2°), while rTSA demonstrated significantly lower glenoid radiolucency rates (9.3% vs 41.9%).
Key Limitation
The 41.9% radiolucency rate in the aTSA group is reported without grading severity or correlation to clinical symptoms, making it impossible to determine whether these findings represent early failure or benign stress shielding at 2 years.
Original Abstract
BACKGROUND
Addressing posterior glenoid deficiency in glenohumeral osteoarthritis (GHOA) with an intact rotator cuff remains contentious among shoulder surgeons. Both reverse total shoulder arthroplasty (rTSA) and anatomic total shoulder arthroplasty (aTSA) with an all-polyethylene posterior augmented glenoid (PAG) are viable options for GHOA with eccentric posterior wear, but aTSA with a PAG has not been directly compared to rTSA in this population. This study compares clinical outcomes of aTSA with a PAG to rTSA in patients with GHOA and Walch B2 or B3 glenoids.
METHODS
This retrospective matched cohort analysis used prospectively collected data to evaluate outcomes of aTSA with a PAG versus rTSA in patients with GHOA and B2/B3 glenoid deformities. Inclusion criteria were age > 18, intact rotator cuff, shoulder arthroplasty between 2017-2023, and minimum two-year follow-up. Patient-reported outcome measures (PROMs), range of motion (ROM), and complications were collected postoperatively. Multivariable linear regression identified preoperative factors associated with final outcomes, and propensity score matching (age, sex, retroversion) was used to compare groups.
RESULTS
Of 208 shoulders (98 aTSA, 110 rTSA), aTSA patients were younger (62.2 ± 8.2 vs 72.7 ± 6.7 years, p < 0.001) and more often male (89.2% vs 50.0%, p < 0.001). Preoperative retroversion was greater in the rTSA cohort (22.7 ± 8.0° vs 19.4 ± 7.1°, p = 0.002). Both groups showed substantial postoperative improvement in ROM and PROs. After propensity matching (36 per group), outcomes remained comparable, including ASES (87.8 ± 13.1 vs 88.6 ± 10.7, p = 0.79), SANE (87.2 ± 12.7 vs 86.2 ± 10.6, p = 0.74), VAS pain (1.6 ± 1.8 vs 1.4 ± 1.7, p = 0.66), and physical/mental health scores. aTSA yielded significantly greater external rotation (47.7 ± 11.2° vs 39.3 ± 7.0°, p < 0.001) and forward flexion (157.9 ± 14.3° vs 144.7 ± 23.7°, p = 0.016). MCID and substantial clinical benefit rates were similar between cohorts. Revision rates were low and comparable (3.1% vs 2.5%, p = 1.0). Radiolucency was significantly more common after aTSA (41.9% vs 9.3%, p < 0.001).
CONCLUSION
Both aTSA with a PAG and rTSA provide excellent 2-year outcomes for GHOA with posterior glenoid deficiency, with no meaningful PROM differences. aTSA may offer better postoperative ROM, while rTSA may confer lower radiolucency rates.
LEVEL OF EVIDENCE
Level III, Retrospective Cohort Comparison, Treatment Study.