BACKGROUND: Over the last decade, due to the increase in the number of shoulder arthroplasty procedures performed, revision to reverse total shoulder arthroplasty (rTSA) has increased by 392%. This rise has been associated with a greater incidence of complications, including implant loosening and bone loss requiring alternative strategies for management of failed arthroplasty with glenoid bone deficiency. The purpose of this paper is to review the current literature and compare outcomes of different grafts and custom implants used to address severe glenoid defects for revision of failed shoulder arthroplasty. METHODS: A systematic search of three databases (PubMed, Elsevier, CINAHL) identified articles on severe bone loss during revision to rTSA. Articles were categorized into bone graft types, including allograft, autograft, and custom implant cohorts. Complications were evaluated, and outcomes were compared to previously published Minimal Clinically Important Difference (MCID) values. RESULTS: Thirteen articles produced 556 shoulders (57% female), mean age 68 (35 - 93 age range), all with a two-year minimum follow up. After filtering those shoulders which underwent revision rTSA, 232 shoulders remained. Bone grafting accounted for 58% of cases, while 32% received custom implants. Shoulders in which bone grafting was utilized had ASES, Constant scores, and SST that all achieved MCID thresholds. Range of motion testing showed all shoulders achieved MCID for abduction and forward elevation, while only 67% and 50% of shoulders achieved MCID for external rotation and internal rotation, respectively. In the custom implant cohort, all shoulders (100%) achieved the minimal clinically important difference (MCID) in all outcome measures. Complication rates (19% vs 28%) differed between cohorts, with implant loosening (25%), instability (21%), and fracture (17%) being the most common types. The percentage of complications necessitating re-revisions was similar between the bone grafted (48%) and custom implant (52%) cohorts. Subgroup analysis of bone graft type revealed, complications requiring additional revision were predominantly seen in shoulders reconstructed with femoral head allografts (85%), compared with only 15% involving iliac crest or proximal humeral head autografts. CONCLUSION: Both strategies, including bone grafting with conventional implants and the use of custom implants for structural glenoid defects, achieved MCIDs and meaningful improvements in patient function and pain. Subgroup analysis suggests that autograft may be a more reliable option than allograft in the setting of severe glenoid defects during revision rTSA. However, these findings are derived primarily from Level IV studies and may be subject to multiple sources of bias; therefore, higher-quality comparative studies are needed to confirm these observations.
Henke et al. (Fri,) studied this question.