Improved surgical techniques and outcomes with anatomic total shoulder arthroplasty managing B2 glenoids in midterm-follow-up: A systematic review

Background The aim of this systematic review was to study the outcomes of anatomic total shoulder arthroplasty (aTSA) in B2 glenoids before and after the 2012 publication by Walch et al., which recommended the use of reverse TSA (rTSA) for Walch Type B2 glenohumeral joint arthritis. Methods Using PRISMA guidelines, publications were identified that reported on the outcomes for aTSA used in the management of B2 glenoids. Only studies with at least 2 years of follow-up were considered. Results In the two groups, pre-2012 and post-2012, a total of 779 osteoarthritic B2 shoulders were treated with an aTSA. The average follow-up was 59.32 versus 51.14 months. Over the past 10 years, prosthesis-related complication rates using eccentric reaming have significantly decreased from 13.15% to 3.28% (odds ratio: 3.5; p = 0.0002; confidence interval [CI]: 1.49–8.64). The use of posterior augmented glenoid implants has increased substantially and has maintained a consistently low complication rate of 2.8% (odds ratio: 0.64; p = 0.684, CI: 0.12–3.25), with a mean follow-up of 32.7 months. In the first group (pre-2012), after the implantation of 171 prostheses, 19 complications occurred (11.11%), whereas in the second group (post-2012), 18 complications occurred after 608 operations (2.96%). When combining all surgical options for aTSA in the presence of a B2 glenoid, the results showed that patients after 2012 had significantly lower revision rates compared to patients before 2012 (odds ratio: 3.12; p = 0.0012 CI: 1.56–6.1). Conclusion The outcomes of aTSA since 2012 have improved with lower prothesis-related complication rates when eccentric reaming and posterior augmented glenoid components were used.