Outcomes of Corrective, Concentric (C2) Glenoid Reaming combined with Pyrocarbon Hemiarthroplasty for B2, B3 Glenoid Arthritis.

ABSTRACT

BACKGROUND: Posterior humeral subluxation (PHS) in B2/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 (ATSA) and painful glenoid erosion in hemiarthroplasty with metallic heads (HA-Metal). We hypothesized that corrective and concentric reaming (CCR) 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/active patients with B2/B3 glenoid. METHODS: Between 2014 and 2020, 41shoulders (in 35 patients, mean age of 57.9 years) underwent HA-PYC combined with CCR 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, 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 to 9.5 years), the prosthesis survival was 95% (39/41). 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=0.001), and the mean PHS from 74% to 56.5% (p=0.001) 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<0.001). 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<0.001). Overall, 84% of active patients returned to work and all patients returned to sports. CONCLUSION: In B2/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 mid-term follow-up. The combined procedure results in excellent functional outcomes and high prosthesis survivorship at mid-term follow-up. HA-PYC and CCR is offering an alternative shoulder arthroplasty for young/active patients with B2/B3 glenoid osteoarthritis who want to return to work or sports practice.