Revision of the loose glenoid component in anatomic total shoulder arthroplasty

Loosening of the glenoid component is a frequent cause of failure of total shoulder arthroplasty (TSA). The etiology of glenoid component loosening is multifactorial and includes aseptic osteolysis, rotator cuff insufficiency, soft tissue instability, and infection. A loose glenoid component is frequently associated with a substantial loss of glenoid bone, which necessitates additional procedures to implant a new component. Several studies have shown that patients with a new glenoid component have better clinical outcomes, which makes successful glenoid reimplantation a priority. The reconstructive options when facing a loose glenoid component in anatomic total shoulder arthroplasty include the established techniques of reaming the high side or bone grafting the deficient glenoid combined with a one or two stage revision. Augmented glenoid components may allow surgeons to limit eccentric reaming or the extent of bone grafting necessary in a bone deficient glenoid. The reverse total shoulder arthroplasty (rTSA) is emerging as a useful reconstructive option capable of addressing bony and soft tissue problems encountered in revision TSA. The ream-and-run procedure remains the least desirable option in the face of significant glenoid bone deficiency. The increasing use of augmented glenoids and rTSA in revision TSA may provide opportunities for new areas of clinical outcomes research in this challenging reconstructive problem.