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

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. 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. 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). 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.