Humeral and glenoid bone loss in shoulder arthroplasty. Classification and treatment principles

The treatment of bone defects in primary shoulder arthroplasty has evolved due to more detailed diagnostic tools, 3D planning and expanded indications for reverse shoulder arthroplasty. Glenoid bone defects combined with chronic posterior subluxation of the humeral head are gradually being treated by glenoid reconstruction and reverse implants even if the rotator cuff is still intact. The treatment of advanced bone loss due to glenoid loosening has been facilitated by bone augmentation using a cementless fixation as proposed by Norris. Precise pre-operative planning using reformatted computed tomography (CT) and dedicated instruments is recommended in primary and revision arthroplasty. Revision rates and complications are high for revision surgery in extended glenoid and humeral bone loss. Functional results are limited in these cases, particularly after multiple operations and damage of the soft tissue envelope.