Proximal Humerus Bone Loss in the Setting of Reverse Total Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• Proximal humerus bone loss (PHBL) complicates reverse total shoulder arthroplasty (RTSA), particularly in revision cases.
• PHBL can negatively impact the deltoid moment arm, soft tissue attachments, and component stability.
• The etiology of PHBL is multifactorial, with significant patient-to-patient variability in bone loss severity.

Purpose of the Study:

• To review and discuss current treatment strategies for proximal humerus bone loss in the context of reverse total shoulder arthroplasty.
• To highlight the advantages and limitations of various reconstructive techniques.
• To emphasize the necessity of individualized treatment planning for patients with PHBL.

Main Methods:

• Literature review of surgical management options for PHBL in RTSA.
• Analysis of reconstructive techniques including long-stem prostheses, cementoplasty, allograft reconstruction, endoprosthesis, and 3D-printed implants.
• Discussion of the biomechanical and clinical implications of each method.

Main Results:

• Multiple surgical options exist for addressing PHBL, including long-stem prostheses, cementoplasty, allograft reconstruction, proximal humerus endoprosthesis, and custom 3D-printed solutions.
• Each technique offers distinct benefits and drawbacks.
• Successful management hinges on tailoring the approach to the specific patient's bone loss and anatomical considerations.

Conclusions:

• Proximal humerus bone loss is a complex challenge in revision reverse total shoulder arthroplasty.
• A range of reconstructive options are available, each with specific indications and limitations.
• Individualized treatment strategies are crucial for optimizing functional outcomes in patients undergoing revision RTSA for PHBL.