Reverse total shoulder for severe glenoid defects.

 As emphasized by the authors of Functional and Radiographic Outcomes of Bone Grafting for Severe Glenoid Defects in Reverse Shoulder Arthroplasty, reverse total shoulder arthroplasty is commonly used to manage shoulders with major glenoid defects from either primary arthritis or from revision arthroplasty. One approach to these defects is using bone graft to fill in the defect . 

They report their outcomes for 20  primary arthroplasties

and 17 revision arthroplasties

 in which bone autograft (humeral head) or allograft (femoral head) was used to fill the defect prior to inserting a baseplate with a long central post.

Most primary arthroplasties had autografting while all revisions had allografting.

Of the 8 cases of baseplate failure (22% of the 37) at five years after surgery.

    8 had a Charleson Comorbidity Index of 3 or less (i.e they were pretty healthy)

    7 were in males    

    7 were in revision cases

    7 were in cases were allograft was used

    7 had graft resorption on the final radiograph    

    6 had gross shift of the baseplate on final radiograph

The authors noted that in contrast to the autograft cases, a substantial number of the allograft cases failed more than two years after arthroplasty, suggesting that lack of healing or resorption of the graft may be causative.

Comment: This report suggests that when using a baseplate with a long central post in healthy male patients having revision arthroplasty,  the use allograft may increase the rate of baseplate failure in the intermediate term. It seems possible that using a baseplate with a central compressive screw might yield better outcomes in these high risk cases, but this has not been rigorously established. Other alternative approaches might include augmented or custom baseplates. 

Getting durable purchase seems important for getting the job done

Lewis's Woodpecker

Oak Creek Wildlife Area

Washington 

2020

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).