Is bone grafting always necessary in revision reverse total shoulder arthroplasty with uncontained glenoid bone defects?

Background: Patients with an uncontained glenoid bone defect can still successfully undergo a reverse total shoulder arthroplasty (RTSA). Currently, there is a tendency toward reconstruction of the premorbid glenoid plane with bone grafts, which is technically demanding. We investigated whether central peg positioning in the spine pillar (CPPSP) is a more feasible alternative to the use of bone grafts. Methods: This study included 60 revisions to an RTSA with uncontained glenoid bone defects. Patients were treated with bone grafts in 29 cases and with the CPPSP technique in 31 cases. We assessed clinical results using the Constant score and assessed the complication rate. Results: The Constant score changed from 42 to 69 points in the CPPSP group and from 47 to 60 points in the bone graft group. This difference in the increase in the Constant score was significant (P = .031) owing to a significant difference in strength in favor of the CPPSP group. The overall complication rate was 37.7% (20 of 53 patients), with a reoperation rate of 18.9% (10 of 53). Dislocations occurred only in the CPPSP group (n = 3), and loosening of the glenoid occurred only in the bone graft group (n = 3). Conclusion: Patients with uncontained glenoid bone defects undergoing revision to an RTSA obtain similar clinical results with the CPPSP technique compared with the use of bone grafts. The CPPSP technique is a valid alternative but results in different complications. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Automated summary

This study indicates that in patients with uncontained glenoid bone defects undergoing revision to an RTSA, the use of the CPPSP technique can achieve similar clinical outcomes compared to using bone grafts. While the CPPSP technique results in a significant increase in strength, it may lead to different complications that need to be carefully considered.