Revision of Cemented Reverse Total Shoulder Arthroplasty with Bone Graft in Osteogenesis Imperfecta: A Case Report

Reverse total shoulder arthroplasty (RTSA) has many indications, including acute proximal humerus fracture or nonunion of such a fracture. However, we are unaware of any reports of the use of RTSA to treat proximal humerus fractures in patients with osteogenesis imperfecta (OI).

Here, we describe the challenges of RTSA for fracture nonunion in a 67-year-old woman with OI. The humeral component of the prosthesis loosened, and aspiration revealed 2 organisms. She underwent placement of an antibiotic spacer, after which cultures were negative. A second revision was then performed, during which a cemented proximal humeral component was implanted as part of the RTSA system. Subsequently, she fell, fracturing the humerus, which was treated with internal fixation with plates reinforced with a fibular allograft. The RTSA humeral component subsequently loosened, and she was revised to an allograft prosthetic composite. She subsequently healed but died after a fall in her home.

Prompt identification and management of complications are crucial for improving outcomes of RTSA in patients with OI.