Reverse Total Shoulder Replacement in Patients with Severe Glenoid Bone Loss

A commonly cited contraindication to reverse total shoulder arthroplasty is deficient glenoid bone stock. Deficient glenoid bone stock can lead to inadequate glenoid baseplate fixation and, eventually, glenoid component loosening and prosthesis failure. However, with improved prosthetic designs and increased surgeon experience, indications for use of reverse total shoulder arthroplasty continue to expand to include shoulders that would have previously seemed doomed to failure if treated with a reverse prosthesis. In this article, 3 cases are presented, 1 of cuff tear arthropathy and 2 of chronic anterior dislocations, in whom primary reverse total shoulder arthroplasty was performed despite the presence of severe glenoid bone deficiency. Corticocancellous bone grafting was used at the time of the reverse arthroplasty to augment the deficient glenoid and allow for simultaneous and adequate glenoid component fixation. All 3 cases showed excellent results in short-term follow-up, providing surgeons with an option for how to treat these difficult shoulders.