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

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 and 2023, and minimum 2-year follow-up. Patient-reported outcome measures, range of motion (ROM), and complications were collected postoperatively. Multivariable linear regression identified pre-operative factors associated with final outcomes, and propensity score matching (age, sex, and 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 < .001) and more often male (89.2% vs. 50.0%, P < .001). Pre-operative retroversion was greater in the rTSA cohort (22.7 ± 8.0° vs. 19.4 ± 7.1°, P = .002). Both groups showed substantial post-operative improvement in ROM and PROs. After propensity matching (36 per group), outcomes remained comparable, including American Shoulder and Elbow Surgeons (87.8 ± 13.1 vs. 88.6 ± 10.7, P = .79), Single Assessment Numeric Evaluation (87.2 ± 12.7 vs. 86.2 ± 10.6, P = .74), visual analog scale pain (1.6 ± 1.8 vs. 1.4 ± 1.7, P = .66), and physical/mental health scores. aTSA yielded significantly greater external rotation (47.7 ± 11.2° vs. 39.3 ± 7.0°, P < .001) and forward flexion (157.9 ± 14.3° vs. 144.7 ± 23.7°, P = .016). Minimal Clinically Important Difference 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 < .001). CONCLUSION: Both aTSA with a PAG and rTSA provide excellent 2-year outcomes for GHOA with posterior glenoid deficiency, with no meaningful patient-reported outcome measure differences. aTSA may offer better post-operative ROM, while rTSA may confer lower radiolucency rates.