Technique for Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis with a Biconcave Glenoid.

INTRODUCTION:Our technique to treat a biconcave glenoid (severe B2 subtype) with reverse total shoulder arthroplasty corrects the humeral head subluxation and associated posterior glenoid bone loss, both of which are difficult to address with a conventional anatomic arthroplasty procedure. STEP 1 PREOPERATIVE PLANNING:Obtain a preoperative computed tomography (CT) scan and make a detailed preoperative plan for reaming and bone-grafting. STEP 2 SURGICAL APPROACH:Perform a standard deltopectoral approach. STEP 3 HUMERAL PREPARATION:Prepare the humerus in a way that allows you to retain the humeral head for bone-grafting, being careful not to make an overly conservative first cut that effectively splits the intended bone graft. STEP 4 GLENOID EXPOSURE:Proper glenoid exposure is an essential element of this operation and even more difficult for the B2 glenoid than in a standard total shoulder replacement. STEP 5 GLENOID PREPARATION:Having adequately visualized the glenoid, ream the anterior aspect of the glenoid in a way that executes your preoperative plan; do not ream >1 cm. STEP 6 GLENOID FIXATION:Use the screws to compress the bone graft between the metaglene and the native glenoid. STEP 7 CLOSURE:Proceed with your standard closure. RESULTS:We presented our results of this procedure in twenty-seven shoulders in twenty-seven patients with a mean duration of follow-up of fifty-four months (range, twenty-four to 139 months).IndicationsContraindicationsPitfalls & Challenges.