Customized tantalum-augmented reverse shoulder arthroplasty for glenoid bone defect and excessive medialization: description of the technique.

Background: Glenoid bone defect and excessive medialization could represent challenging issues during reverse shoulder arthroplasty, especially in the setting of revision surgery. Although a solution is offered by the Boileau's BIO-RSA technique in primary cases, only autologous iliac crest bone graft and homologous graft from bone banks are available for revision surgeries, with known disadvantages and risk of graft resorption and implant failure.
Materials and Methods: We describe in this work a new technique based on a customized porous tantalum device to be used in salvage situations, aimed at lateralization of the glenoid component of a reverse shoulder arthroplasty. Between 2014 and 2015, five patients received a customized tantalum-augmented RSA at our institution. The augments we applied are actually on the market for acetabular bone loss management: these were opportunely prepared and fixed to the metal back of the glenoid component before implantation.
Results: In the five cases treated, no major or minor complications have been recorded to date. Despite the short follow-up, all the implants are still in situ. All of the patients referred complete subjective satisfaction and return to their daylife activities without pain within 4 months after surgery.
Conclusions: The customized tantalum-augmented RSA technique represents in our experience a useful and safe solution in managing glenoid bone loss and medialization. Adaptability to virtually every device in the market should be regarded as important point of strength of this technique.