Current treatment options for severe glenoid bone loss in revision shoulder arthroplasty: a systematic review and meta-analysis.

Abstract

Failed shoulder arthroplasty often presents with glenoid bone loss, posing a challenge for both surgeons and patients. This study aimed to evaluate the available revision strategies for failed shoulder arthroplasty in the presence of severe glenoid bone loss. Severe bone loss was defined as a glenoid that is not capable of reconstruction using a standard reverse total shoulder glenoid or augmented baseplate. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PubMed and Google Scholar were systematically searched for revision -shoulder- arthroplasty - glenoid bone loss by two authors independently. Statistical analysis was performed using RevMan software. Initially, 249 references were retrieved. After duplicate removal and abstract and title screening, 40 full-text studies comprising of 656 patients met eligibility criteria. The mean patient age was 67.7 years (range 62.4-71.2), with a mean follow-up of 33 months (range 16-50). Regarding functional outcomes, custom glenoid implants demonstrated the greatest improvements in ASES and Constant scores, with mean differences (MDs) of 42.4 and 35.8, respectively (P < .001 for both). Custom implants also provided the best pain relief (MD 5.79, P < .001). For range of motion, bone grafting with reverse total shoulder arthroplasty (rTSA) provided the best improvements in external rotation (MD 21.0°) and forward flexion (MD 67.4°) (P < .001 for both). Custom glenoid implants provided the best functional outcomes and pain relief in revision shoulder arthroplasty with glenoid bone loss. The findings of this study would suggest that given in the short term of superior performance in improving pain, with higher ASES and Constant scores, custom glenoid components warrant further long term study of these issues and long term survival of the implants.