Challenges in Reverse Shoulder Arthroplasty: Addressing Glenoid Bone Loss

Reverse shoulder arthroplasty (RSA) was designed for the treatment of elderly patients with cuff tear arthropathy. Because of its success, the indications for RSA have expanded beyond cuff tear arthropathy to include acute fractures, fracture sequelae, massive rotator cuff tears, inflammatory arthritis, and revision shoulder arthroplasty. Consequently, the number of RSAs performed has increased steadily. Glenoid bone loss is not uncommon in patients undergoing primary or revision RSA. Failure to appreciate and address glenoid bone loss during RSA can lead to improper baseplate positioning and early failure or complications such as dislocation or scapular notching. The authors present a review of the current literature as well as recommended strategies for characterization of glenoid bone loss and preferred surgical techniques for addressing bone loss during RSA.