Management of Glenoid Bone Defects in Revision Shoulder Arthroplasty

Abstract

Surgical treatment of failed shoulder arthroplasty is extremely challenging. Moreover, a failed shoulder replacement with glenoid bone loss and rotator cuff dysfunction is a complex surgical combination that historically has no reliable or satisfactory method of treatment. To address this problem, the senior author (TRN) has developed a method of single-stage reconstruction using the reverse total shoulder prosthesis. Glenoid deficiency is treated using a tricortical iliac crest bone graft, which is secured using the fixation screws and central peg of a custom, long post (25 or 30 mm) reverse prosthesis baseplate. The reverse humeral component is implanted in standard fashion. The advantage of this technique is that it addresses both the functional impairment caused by the rotator cuff deficiency and the structural compromise to the glenohumeral joint caused by glenoid bone loss. The purposes of this study are to present the technique and to demonstrate the practicality of treatment of this complex problem, with a 1-stage solution.