Introduction Reverse shoulder arthroplasty has emerged as a very good treatment option for patients in salvage situations, such as the revision setting with glenoid bone loss.
Indications & Contraindications
Step 1: Preoperative Evaluation and Planning For patients undergoing revision shoulder arthroplasty, perform the preoperative evaluation with radiographs, computed tomography (CT), and digital templating software as they play a key role (Video 1).
Step 2: Surgical Approach and Humeral Component Management Perform all operations with the patient in the beach-chair position.
Step 3: Glenoid Component Removal and Preparation Glenoid exposure is the key to the operation.
Step 4: Assessment of Glenoid Bone Stock and Bone-Grafting Algorithm Use bone graft if the glenoid is thought to be inadequate for stable fixation in an acceptable position.
Step 5-A: Manage a Peripheral Defect with ≥50% Implant-Bone Contact with a Structural Allograft or Humeral Autograft When a peripheral defect contributes to either glenoid anteversion (anterior) or retroversion (posterior), but the implant has ≥50% contact with the native bone, consider using a structural autograft from the local humerus (preferred), if available, or a structural allograft (Video 1).
Step 5-B: Manage a Peripheral Defect with <50% Implant-Bone Contact with a Structural Autograft from the Iliac Crest or Proximal Part of the Humerus In shoulders with a peripheral defect with <50% contact with the native glenoid and substantial alterations in glenoid version, consider using a structural autograft from the proximal part of the humerus (preferred), if available, or the iliac crest (Figs. 2-A, 2-B, 2-C, and 3; Video 1).
Step 5-C: Manage a Central Defect with ≥30% Implant-Bone Contact with Morselized Bone-Grafting (Allograft or Autograft) In shoulders with a central defect with ≥30% contact between the baseplate and the native glenoid, with adequate primary stability of the central screw and/or peg, …
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