Current treatment options for severe glenoid bone loss in revision shoulder arthroplasty: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared revision strategies for failed shoulder arthroplasty with severe glenoid bone loss, defined as bone loss not reconstructable with a standard or augmented reverse shoulder baseplate. Forty studies involving 656 patients were included; mean follow-up was 33 months. Custom glenoid implants showed the greatest improvements in American Shoulder and Elbow Surgeons and Constant scores (mean differences 42.4 and 35.8, respectively; P < .001 for both) and pain relief (mean difference 5.79; P < .001). Bone grafting with reverse total shoulder arthroplasty produced the greatest gains in external rotation and forward flexion.

Key findings

• Across 40 studies and 656 patients, mean follow-up was 33 months.
• Custom glenoid implants had the greatest improvements in American Shoulder and Elbow Surgeons and Constant scores: mean differences 42.4 and 35.8, respectively (P < .001 for both).
• Custom implants provided the best pain relief (mean difference 5.79; P < .001).
• Bone grafting with reverse total shoulder arthroplasty yielded the greatest improvements in external rotation (mean difference 21.0°) and forward flexion (mean difference 67.4°; P < .001 for both).

Why it matters

Severe glenoid bone loss complicates revision shoulder arthroplasty and limits standard reconstruction options. The review suggests that outcomes differ by strategy: custom implants were associated with better functional scores and pain relief, while bone grafting with reverse arthroplasty produced larger motion gains. These comparisons can inform discussion of available approaches, while the evidence remains short term.

What to keep in mind

The evidence came from 40 studies with a mean follow-up of 33 months; the abstract does not report long-term implant survival, which the authors identify as needing further study.