Pitfalls of revision reverse replacement part II: dealing with humeral bone loss and periprosthetic fractures

Reverse total shoulder arthroplasty (RSA) has a complication rate of ~15% when used in the primary setting and can be higher in the revision setting. Complications related to the humerus include intraoperative or postoperative periprosthetic fractures and proximal humeral bone loss can also result in humeral bone loss. Non-operative treatment of fractures may be used for patients with stable implants and well-aligned fractures or those unsuitable for surgery. Operative techniques include implant revision, usually with a longer stem, and/or open reduction and internal fixation (ORIF) with some combination of plates, screws, cortical graft strut, and wires/cables. For patients with significant humeral bone loss, options include revision RSA without allograft, allograft prosthesis composite (APC), and endoprosthetic replacement. Each has their advantages and disadvantages without an agreed upon accepted standard of care. Unfortunately, treatment of periprosthetic fractures and proximal humerus bone loss both have high complications rates.