Surgical options for the management of severe glenoid structural deficiencies in the setting of revision reverse shoulder arthroplasty: a systematic review.
Robert T Henke, Robert J Resis, Jacqueline G Tobin et al.
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In 30 seconds
This systematic review compared bone grafting and custom implants for severe glenoid bone loss during revision reverse total shoulder arthroplasty (rTSA). Thirteen articles included 556 shoulders, with 232 remaining after selection of revision rTSA cases; all had at least 2 years of follow-up. Both approaches achieved clinically meaningful improvements. Complication rates were 19% with bone grafting and 28% with custom implants, while the proportion of complications requiring re-revision was similar (48% vs. 52%). The authors note that evidence was primarily from level IV studies and is vulnerable to bias.
Key findings
- Bone-grafted shoulders achieved MCID thresholds for American Shoulder and Elbow Surgeons, Constant, and Simple Shoulder Test scores.
- All shoulders in the custom implant cohort achieved MCID in all reported outcome measures.
- Complication rates were 19% with bone grafting and 28% with custom implants; re-revision accounted for 48% and 52% of complications, respectively.
- Complications requiring further revision were predominantly associated with femoral head allografts (85%), versus 15% with iliac crest or proximal humeral head autografts.
Why it matters
Severe glenoid bone loss complicates revision rTSA, and this review indicates that both graft-based reconstruction and custom implants can yield meaningful functional improvement. The findings also raise the possibility that outcomes differ by graft source. However, the evidence base is largely low-level and does not establish which strategy is superior, so comparative results should be interpreted cautiously.
What to keep in mind
The findings derive primarily from level IV studies and may be affected by multiple sources of bias; higher-quality comparative studies are needed.