Glenoid bone loss is a common and difficult problem in reverse shoulder arthroplasty, seen with cuff tear arthropathy, chronic dislocation, and failed prior arthroplasty. This single-center case series proposes an intraoperative classification of glenoid defects and asks whether severe bone loss can be reconstructed with a single-stage bone graft and RSA. It reports the technique, the fixation criteria required, and the clinical and radiographic outcomes.
When you face glenoid bone loss during RSA, the decision that matters is whether you can get primary baseplate stability in one stage.
This paper gives you a concrete rule: the 50% rule. If at least 50% of the baseplate sits on native glenoid, at least 50% of the peg is in native scapula, and you have 2 opposing locked screws in native bone, proceed single-stage with a bone graft. If not, stage it.
The teaching point is that outcome tracked with fixation, not defect size. Defect grade, location, and indication showed no correlation with results, and the single early failure was the one case where the 50% rule was broken.
RSA tolerates glenoid grafting far better than anatomic TSA because the fixed baseplate compresses the graft, promoting incorporation instead of the subsidence that plagued cemented glenoids. Preserve bone: 2 mm of extra reaming drops residual bone compressive strength by 70%.
Glenoid bone loss is a common and difficult problem in reverse shoulder arthroplasty, seen with cuff tear arthropathy, chronic dislocation, and failed prior arthroplasty. This single-center case series proposes an intraoperative classification of glenoid defects and asks whether severe bone loss can be reconstructed with a single-stage bone graft and RSA. It reports the technique, the fixation criteria required, and the clinical and radiographic outcomes.
When you face glenoid bone loss during RSA, the decision that matters is whether you can get primary baseplate stability in one stage.
This paper gives you a concrete rule: the 50% rule. If at least 50% of the baseplate sits on native glenoid, at least 50% of the peg is in native scapula, and you have 2 opposing locked screws in native bone, proceed single-stage with a bone graft. If not, stage it.
The teaching point is that outcome tracked with fixation, not defect size. Defect grade, location, and indication showed no correlation with results, and the single early failure was the one case where the 50% rule was broken.
RSA tolerates glenoid grafting far better than anatomic TSA because the fixed baseplate compresses the graft, promoting incorporation instead of the subsidence that plagued cemented glenoids. Preserve bone: 2 mm of extra reaming drops residual bone compressive strength by 70%.