Between 2001 and 2010, these authors found that 94 of 1074 reverse total shoulders had significant glenoid bone loss. Of these patients, 17% had a centric defect
Composite glenoid grafts were required in 12 patients, 9 of whom required a glenoid baseplate with a long central peg.
92.5% (87/94) of the patients could be managed with a single-stage procedure. If the long central peg did not purchase a minimum of 50% of its length in the native scapula, a single-stage reconstruction was aborted in favor of a 2-stage procedure: the glenoid defect was grafted with a composite graft and fixated using cortical screws as required to attain graft stability. In cases of centric defects, a modular humeral component was used and a hemiarthroplasty performed. In cases in which eccentric defects were reconstructed, a resection arthroplasty was performed. In the authors’ experience, a hemiarthroplasty for an eccentric bone defect led to poor graft incorporation and graft nonunion or resorption.
Comment: The key in such cases is that secure baseplate fixation needs to be achieved before the construct is loaded by completing the reverse total shoulder with a glenosphere and a humeral component.
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