Management of Glenoid Bone Loss in Primary Reverse Total Shoulder Arthroplasty

Glenoid bone loss presents distinct challenges in reverse total shoulder arthroplasty (rTSA) which, if unaddressed, can cause complications including poor outcomes and early implant failure. The purpose of this review is to discuss the etiology, evaluation, and management strategies of glenoid bone loss in primary rTSA.

Three-dimensional computed tomography (3D CT) imaging and preoperative planning software have revolutionized the understanding of complex glenoid deformity and wear patterns from bone loss. With this knowledge, a detailed preoperative plan can be created and implemented for a more optimal management strategy. When appropriately indicated, deformity correction techniques with biologic or metal augmentation are successful in addressing the glenoid bone deficiency, creating optimal implant position, and thus providing stable baseplate fixation and improving outcomes. Thorough evaluation and characterization of the degree of glenoid deformity with 3D CT imaging is necessary prior to treatment with rTSA. Eccentric reaming, bone grafting, and augmented glenoid components have shown promising results in correcting glenoid deformity due to bone loss, but long-term outcomes are currently unknown.