This multicenter retrospective case series describes the hemi-reverse procedure — glenoid baseplate and glenosphere implanted without a humeral component — as a staged revision strategy for failed shoulder arthroplasty with severe glenoid bone loss. The study reports graft healing rates, functional outcomes, and feasibility of second-stage conversion to full RSA in 15 patients with a median remaining vault thickness of just 2 mm.
When you encounter a failed shoulder arthroplasty with severe glenoid bone loss and question whether a glenoid baseplate will hold at the time of revision, the hemi-reverse is the answer: implant the baseplate and glenosphere, skip the humeral stem, and let the graft heal under reduced load.
This paper establishes the specific threshold: use this technique when vault thickness is under 5 mm, and ensure the central post engages native bone — the single failure in this series occurred when it did not. Plan for second-stage humeral stem implantation at a minimum of 6 months once imaging confirms healing. Do not rush it; there is no maximum delay.
If a patient elects to keep the hemi-reverse as a definitive implant, counsel them on realistic expectations: modest pain relief and roughly 100° of forward elevation, but progressive humeral bone changes occur in most and require ongoing radiographic follow-up.
This multicenter retrospective case series describes the hemi-reverse procedure — glenoid baseplate and glenosphere implanted without a humeral component — as a staged revision strategy for failed shoulder arthroplasty with severe glenoid bone loss. The study reports graft healing rates, functional outcomes, and feasibility of second-stage conversion to full RSA in 15 patients with a median remaining vault thickness of just 2 mm.
When you encounter a failed shoulder arthroplasty with severe glenoid bone loss and question whether a glenoid baseplate will hold at the time of revision, the hemi-reverse is the answer: implant the baseplate and glenosphere, skip the humeral stem, and let the graft heal under reduced load.
This paper establishes the specific threshold: use this technique when vault thickness is under 5 mm, and ensure the central post engages native bone — the single failure in this series occurred when it did not. Plan for second-stage humeral stem implantation at a minimum of 6 months once imaging confirms healing. Do not rush it; there is no maximum delay.
If a patient elects to keep the hemi-reverse as a definitive implant, counsel them on realistic expectations: modest pain relief and roughly 100° of forward elevation, but progressive humeral bone changes occur in most and require ongoing radiographic follow-up.