Femoral Head Allograft Glenoid Bone Reconstruction in Reverse Shoulder Arthroplasty

Glenoid bone loss remains a significant challenge in both primary and revision reverse shoulder arthroplasty (RSA), particularly following infection, erosion, or component explantation. Adequate reconstruction is critical to restore the native joint line, inclination, and version while ensuring baseplate fixation and long-term stability. Although smaller defects can be addressed with augmented baseplates or humeral head autograft, massive bone loss often requires structural allografting. Femoral head allograft offers a viable and reproducible solution in complex revision cases where autograft is unavailable or unsuitable. This technical note details a 2-stage revision RSA approach utilizing femoral head allograft to address severe glenoid bone loss. In the first stage, the patient is positioned in the beach chair position, and previous components and cement spacers are meticulously removed. The glenoid is debrided and contoured to accept a size-matched femoral head allograft. The graft is prepared using a coring reamer and oscillating saw, trialed for optimal fit, and fixed with cannulated screws. Demineralized bone matrix is applied around the graft to promote incorporation. Importantly, the humeral component is deferred to minimize shear stress across the graft-host interface and enhance graft healing. Once incorporation is confirmed radiographically and cultures return negative, definitive RSA with a lateralized glenosphere and 135° humeral component is performed. This technique reliably restores the joint line and allows for stable baseplate fixation, even in cases with significant medial wear. The femoral head allograft provides robust structural support, facilitates biologic incorporation, and avoids donor site morbidity associated with iliac crest harvest. Our approach shows that femoral head allograft, combined with a lateralized prosthesis, can yield stable, functional outcomes in revision RSA for massive glenoid deficiency.