JSES - 2026-08-01 - Journal Article
Outcomes of revision reverse shoulder arthroplasty utilizing bulk femoral head allograft with a monoblock central screw baseplate for severe glenoid defects with minimum 2-year follow-up.
Phillips T, Beleckas CM, Mousad A, Abdelshaheed J, Levy JC
Topics
Key Takeaway
Bulk femoral head allograft for severe glenoid defects in revision RSA achieved 93.1% 2-year and 90.9% 5-year all-cause implant survival with only 10.3% glenoid-sided complications despite mean native bone contact of only 47.3%.
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Summary
This single-surgeon, single-institution retrospective study evaluated outcomes of revision RSA using bulk femoral head allograft with a monoblock central screw baseplate for severe glenoid defects across 29 patients from 2008–2023. Mean native bone contact was 47.3% (range 10–80%), yet 2-year and 5-year all-cause implant survival reached 93.1% and 90.9%, respectively, with 2 patients requiring re-revision for baseplate failure. All PROMs (ASES, SST, VAS-pain, VAS-function, SANE) and ROM (forward elevation, abduction) improved significantly (P<.001).
Key Limitation
The single-surgeon, single-implant design with only 29 patients and heterogeneous index procedures precludes determining whether outcomes are attributable to the allograft technique, the specific baseplate design, or surgeon expertise.
Original Abstract
BACKGROUND
Revision shoulder arthroplasty in the setting of severe glenoid bone loss presents significant reconstructive challenges. The use of femoral head allograft (FHA) has emerged as a potential solution to restore glenoid bone stock and provide a stable foundation for component fixation. This study evaluates the outcomes and viability of FHA in managing severe glenoid defects during revision procedures.
METHODS
A retrospective review of data collected from 2008 to 2023 from a single surgeon at a single institution using a single reverse total shoulder implant system with a monoblock central screw baseplate. There were 29 patients with a minimum 2-year clinical and radiographic follow-up. All included patients underwent revision reverse shoulder arthroplasty with the use of bulk FHA to fill large glenoid defects. Indications for revision included failure of reverse total shoulder arthroplasty (n = 3), failure of shoulder hemiarthroplasty (n = 5), and failure of anatomic total shoulder arthroplasty (n = 21). Patient-specific variables, radiographic parameters, and both preoperative and postoperative patient outcomes (American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog scale-pain, visual analog scale-function, and Single Assessment Numeric Evaluation were collected. Descriptive statistics were used to analyze significant differences in the data based on the rate of secondary procedure for glenoid-sided failure as the primary outcome. Secondary outcomes included changes in patient-reported outcome measures.
RESULTS
29 patients met inclusion criteria with a mean follow-up of 5.57 years. The average baseplate contact to native bone was 47.3% (10%-80%). There were 3 patients (10.3%) who observed with glenoid-sided complications. One patient had early radiographic detection of glenoid-sided loosening without mechanical symptoms (13.5 months), while the other 2 patients had baseplate failures (15.0 and 24.7 months) requiring a subsequent revision surgery. All-cause 2-year implant survival was 93.1% (27/29), 5-year implant survival was 90.9% (20/22), and 10-year implant survival was 87.5% (14/16). There were significant improvements in all patient-reported outcome measures between preoperative and postoperative states (P < .001). There were significant increases in patient forward elevation (P < .001) and abduction (P < .001).
CONCLUSION
Use of FHA in the management of severe glenoid defects during revision reverse shoulder arthroplasty results in significant increases in patient-reported outcomes and range of motion with a low percentage (10.3%) of glenoid-sided complications. All-cause 2-year and 5-year implant survival is greater than 90% with most failures occurring within 15 months of the initial surgery.