JSES published "Total shoulder replacement surgery with custom glenoid implants for severe bone deficiency."
The authors present seven cases in which they used a small custom glenoid implant that was inset within the remaining bone of shoulders with erosion. While the three-year results showed improvement without complications, there are several concerns about this approach. (1) The rationale for a custom component is that it avoids penetration of the keel used in some commercial components. However, when a standard pegged glenoid component is used there have been no problems associated with peg penetration. (2) The technique requires a custom component not generally available. (3) Because the component is inset rather than onset, it does not take advantage of all the bone available for support of the glenoid component in these cases where severe glenoid erosion has already taken place. (4) The short single glenoid peg would seem to offer less resistance to eccentric glenoid loading with perhaps increased risk of rocking horse loosening.
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