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Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 15 June 2025 | Viewed by 12375

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Special Issue Editors

Dr. Stefan Bauer

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Guest Editor

1. Service d’Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
2. School of Surgery, University of Western Australia, Perth, Australia
Interests: shoulder arthroplasty; optimization of reverse shoulder arthroplasty; lateralization; 3D planning; shoulder instability; Latarjet; subscapularis repair; rotator cuff repair

Dr. Allan W. Wang

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Guest Editor

School of Surgery, University of Western Australia, Perth, Australia
Interests: shoulder arthroplasty; optimization of reverse arthroplasty; shoulder arthroscopy; elbow and hand surgery

Dr. William G. Blakeney

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Guest Editor

1. Associate Professor, Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
2. Department of Surgery, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
Interests: orthopaedic trauma; shoulder, hip and knee surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Jean-David Werthel

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Guest Editor

Service d’Orthopédie et de Traumatologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
Interests: optimization of reverse shoulder arthroplasty; soft tissue assessment and planning; shoulder instability; tendon transfers; shoulder arthroscopy

Special Issue Information

Dear Colleagues,

Reverse shoulder arthroplasty (RSA) has become the mainstay of shoulder arthroplasty in the 21st century and is considered the most important breakthrough and innovation in upper limb arthroplasty in the last 50 years.

Surgical planning for RSA is critical to achieving optimal implant positioning. Initially, basic templating used radiographs or 2D CT scans as a reference; this shifted to a patient-specific implantation (PSI) approach with the introduction of 3D software. More recently, CT-based navigation has also been developed, followed by the advent of mixed and augmented reality—bringing the surgical plan into the field of view of the operating surgeon. Surgery can be guided by augmented-reality-based navigation and optimized using robotic reaming and saw cuts. However, in times of limited resources and tight budgets, questions arise about whether these developments are cost-effective for clinical improvements, in terms of “time to return to activities of daily living” and long-term outcomes. Are these improvements measurable? Additionally, in which cases should we be using this technology?

Artificial intelligence (AI) has become more readily available and can help us find the best implant combination and position. AI can learn from the previous actions of experienced surgeons and deep learn “the best way” to implant for a given case.

In terms of planning rotator cuff tendon and deltoid tension, the integration of muscle volume and fatty infiltration and the integration of scapulothoracic posture, motion and kinematics, we are only in the early stages of an exciting field of research that has been overlooked for a long time due to a lack of valid assessment tools.

The biomechanics of RSA have shifted from Grammont’s design, with a medialized center of rotation and a long moment arm, to the modern lateralized RSA. Lateralized RSA can be performed in different ways, with lateralization of the glenoid, humerus or combined, and with different amounts of distalization, lengths of moment arms and neck shaft angles. Some developers speak of “biomechanical” RSA lateralization (longer moment arms) and “anatomic” RSA lateralization, with closer to normal muscle length with better contractility.

There are still many questions to be answered, and the fascinating journey of RSA lies ahead of us. The aim of this Special Issue is to provide an overview of the new “tools” available on the market and present advances in soft tissue and scapulothoracic integration, as well as biomechanics and clinical results.

We are looking forward to receiving your contributions to advance our understanding and knowledge in these fields.

Dr. Stefan Bauer
Dr. Allan W. Wang
Dr. William G. Blakeney
Dr. Jean-David Werthel
Guest Editors

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Keywords

reverse total shoulder arthroplasty
cuff tear arthropathy
osteoarthritis
proximal humeral fracture sequelae
revision
long-term outcome
implant design
biomechanics

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Research

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13 pages, 3020 KiB

Open AccessArticle

The Influence of the Joint Volume on the Prevention of Impingement and Elbow-at-Side Rotations: Could the 36 mm Sphere with an Inferior Offset of 2 mm Be the New Gold Standard?

by Marion Besnard, Ramy Samargandi, Osamah Abualross and Julien Berhouet

J. Clin. Med. 2025, 14(7), 2324; https://doi.org/10.3390/jcm14072324 - 28 Mar 2025

Viewed by 208

Abstract

Background: Reverse shoulder arthroplasty (RSA) improves shoulder function in cases of glenohumeral osteoarthritis and rotator cuff arthropathy. The design of the glenosphere influences mobility and scapular impingement. This study evaluates the impact of joint volume on the range of motion (RoM) and identifies design modifications to enhance mobility while reducing the impingement risk. Methods: Thirty-four cadaveric shoulders were implanted with the Aequalis Reversed II^® prosthesis in seven configurations: four with 36 mm spheres (centered, 2 mm eccentric, and lateralized by 5 mm and 7 mm) and three with 42 mm spheres (centered, and lateralized by 7 mm and 10 mm). The joint volumes (inferior, anteroinferior, and posteroinferior) were measured via 3D CT scans. The RoM in adduction and elbow-at-side rotations (IR1 and ER1) was recorded. A statistical analysis identified threshold joint volumes correlating with improved mobility. Results: Larger joint volumes correlated with enhanced mobility. The 42 mm spheres demonstrated better adduction and ER1 compared to those of the 36 mm spheres (p < 0.0001). An inferior volume > 5000 mm³ and anteroinferior/posteroinferior volumes >2500 mm³ were thresholds for significant mobility improvement. Lateralization (≥7 mm) or inferior eccentricity (2 mm) improved the mobility with the 36 mm spheres, with the 36 + 2 configuration offering a practical balance for smaller patients. Conclusions: Increased joint volume enhances mobility, particularly in adduction and elbow-at-side rotations. A sphere with a 2 mm inferior offset or a 42 sphere with 7 mm lateralization optimizes the RoM while minimizing impingement risks. Patient-specific considerations, including anatomy and soft tissue tension, remain essential for optimal prosthesis selection. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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16 pages, 5278 KiB

Open AccessArticle

From Grammont to a New 135° Short-Stem Design: Two-Hand Lever Test and Early Superior–Lateral Dislocations Reveal Critical Role of Liner Stability Ratio and Stem Alignment

by Stefan Bauer, Jaad Mahlouly, Luca Tolosano, Philipp Moroder, William G. Blakeney and Wei Shao

J. Clin. Med. 2025, 14(6), 1898; https://doi.org/10.3390/jcm14061898 - 11 Mar 2025

Viewed by 635

Abstract

Background: In reverse shoulder arthroplasty (RSA), the neck–shaft angle (NSA) has trended downward from 155° to 135° to reduce scapular notching, but concerns about instability persist. To assess superior–lateral stability, we developed the intraoperative two-hand lever test (2HLT). The primary objective was to evaluate the effectiveness of the 2HLT, analyze the learning curve in this first study reporting on the new Perform stem, and compare the liner characteristics of 155° and 135° systems. Methods: In a single-surgeon learning curve study, 81 RSA procedures with the new Perform stem (Stryker) were included. The outcomes included the 2HLT test applied in 65 cases, early dislocations, stem alignment, stem length, liner type/thickness, and complications. The early dislocation rate was compared to 167 prior Ascend Flex RSA procedures (Stryker). The liner characteristics of three 135° systems (Perform/Stryker, Univers/Arthrex, and Altivate/Enovis) were compared to traditional 155° Grammont systems (Delta Xtend/DePuy, Affinis Metal/Mathys, SMR 150/Lima, and Aequalis Reversed/Stryker), focusing on jump height (JH) and the liner stability ratio (LSR). Results: In 63% (31/49) of the cases, the 2HLT detected superior–lateral instability, necessitating a retentive 135° liner. The early dislocation rate in the Perform cohort was 4.9% (0% for retentive liners, 8% for standard liners) versus 0% in the Ascend Flex cohort. The mean effective NSA was 133° (127–144°) for short Perform stems and 135° (129–143°) for long stems. Long Perform stems significantly reduced varus outlier density below 132° and 130° (p = 0.006, 0.002). The 36 mm Perform 135° standard liner has a JH of 8.1 mm and an LSR of 152%, markedly lower than the Altivate (10.0 mm/202%) and Univers (9.7 mm/193%) and similar to traditional 155° Grammont liners (8.1–8.9 mm/147–152%). Perform retentive liners have LSR values of 185–219%, comparable to the established 135° design standard liners (195–202%). In the Perform cohort, early complications included four superior–lateral dislocations (all standard liners, LSR 147–152%) requiring four revisions. Conclusions: Perform standard liners have a lower LSR than the established 135° designs. Retentive Perform liners (LSR > 184%) are comparable to standard liners of established 135° designs and effectively mitigate instability. We recommend discontinuing non-retentive Perform standard liners (NSA 135°, LSR < 158%) due to the 63% superior–lateral instability rate detected with the novel 2HLT, necessitating retentive liners, the documented LSR-NSA implant mismatch, and an early clinical dislocation rate of up to 8%. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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19 pages, 4936 KiB

Open AccessArticle

Mid-Term Outcomes of a Rectangular Stem Design with Metadiaphyseal Fixation and a 135° Neck–Shaft Angle in Reverse Total Shoulder Arthroplasty

by Yacine Ameziane, Laurent Audigé, Christian Schoch, Matthias Flury, Hans-Kaspar Schwyzer, Alessandra Scaini, Emanuele Maggini and Philipp Moroder

J. Clin. Med. 2025, 14(2), 546; https://doi.org/10.3390/jcm14020546 - 16 Jan 2025

Cited by 1 | Viewed by 758

Abstract

Background/Objectives: Classical reverse shoulder arthroplasty (RSA) with a high neck–shaft angle (NSA) of 155° has shown satisfactory outcomes. However, newer RSA designs aim to improve results by modifying the stem design. This study evaluates the 5-year outcomes of a stem design featuring a rectangular metadiaphyseal fixation and a 135° NSA. Methods: This prospective bicentric case series included and longitudinally followed up patients that were treated for cuff arthropathy, massive irreparable rotator cuff tears, or eccentric osteoarthritis using a non-cemented rectangular metadiaphyseal fixation stem with a 135° NSA (Univers Revers, Arthrex, Naples, FL, USA). Subjective and objective functional outcome scores (Constant–Murley Score (CS), Shoulder Pain and Disability Index (SPADI), and Subjective Shoulder Value (SSV)), range of motion (ROM), radiographic outcome, adverse events, complications, and quality of life were investigated. Results: This study enrolled 132 patients (59% female, mean age 75 years, SD 6). At the 5-year follow-up, subjective and objective outcomes significantly improved compared to baseline: CS (32.9 to 71.7, p < 0.001), SPADI (38.7 to 86.2, p < 0.001), and SSV (43.0 to 84.1, p < 0.001). ROM improved in flexion (80° to 142.4°, p < 0.001), abduction (71.5° to 130.2°, p < 0.001), internal rotation (p < 0.001), internal rotation at 90° abduction (12.7° to 45.0°, p < 0.001), and abduction strength (0.8 kg to 5.2 kg, p < 0.001). External rotation remained unchanged (32.1° to 32.0°, p = 0.125), but external rotation at 90° abduction improved (20.9° to 52.7°, p < 0.001). No signs of implant migration, subsidence, shift, tilt, alignment loss, or wear were observed, but scapular bone spur formation (11%), scapular notching grade 1 (10%), bone resorption (10%), and partial humeral radiolucent lines (1%) were reported. Conclusions: Rectangular stems with metadiaphyseal fixation and a 135° neck–shaft angle in RSA consistently improve shoulder function, showing no aseptic loosening and minimal radiological changes at 5 years. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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13 pages, 7213 KiB

Open AccessArticle

Comparing Repaired Subscapularis Tendon Integrity Using Ultrasound in Onlay Versus Inlay Reverse Shoulder Arthroplasty

by Shri Kapilan, Marko Nabergoj, Alexandre Lädermann and Philippe Collin

J. Clin. Med. 2025, 14(2), 416; https://doi.org/10.3390/jcm14020416 - 10 Jan 2025

Viewed by 665

Abstract

Background: The importance of the subscapularis tendon in reverse shoulder arthroplasty (RSA) has been increasingly emphasized lately. Recent studies have indicated that a repaired subscapularis tendon has better functional outcomes. This study is aimed at comparing the healing rate of repaired subscapularis tendons between onlay and inlay Bony Increased Offset-Reversed Shoulder Arthroplasty (BIO-RSA). Methods: This retrospective comparative review covers all patients who underwent BIO-RSA at a single center, comprising 189 cases performed by on a single surgeon from January 2012 till December 2021. We included all patients who underwent subscapularis tenotomy repair and who had a tendon ultrasound (US) examination at six months postoperatively (as requested in this single surgeon’s usual protocol). These patients were divided into two comparable groups, an onlay group and an inlay group. Healing status was determined using the Sugaya classification, with healed subscapularis tendons defined as having Sugaya type I–III integrity and the unhealed tendons as having Sugaya type IV and V integrity. Results: In total, 2 patients were excluded because ultrasound was not performed (they missed their appointment); 187 patients were evaluated; 98 patients underwent an onlay BIO-RSA; and 89 patients underwent an inlay BIO-RSA. The healing rate of the repaired subscapularis tendon was 73% in the onlay group and 56% in the inlay one (p = 0.020). Conclusions: The onlay systems may enhance subscapularis tendon healing compared to the inlay one, possibly due to the preserved intramedullary vascularity and the near-normal tendon excursion that can be achieved by the onlay system. Choosing an onlay design can minimize bone cuts during RSA, while achieving good subscapularis tendon healing. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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18 pages, 3405 KiB

Open AccessArticle

The Use of Glenoid Structural Allografts for Glenoid Bone Defects in Reverse Shoulder Arthroplasty

by Helen Ingoe, Kristine Italia, Luke Gilliland, Hean Wu Kang, Mirek Karel, Jashint Maharaj, Kenneth Cutbush and Ashish Gupta

J. Clin. Med. 2024, 13(7), 2008; https://doi.org/10.3390/jcm13072008 - 29 Mar 2024

Cited by 2 | Viewed by 2253

Abstract

Background: The use of reverse shoulder arthroplasty as a primary and revision implant is increasing. Advances in implant design and preoperative surgical planning allow the management of complex glenoid defects. As the demand for treating severe bone loss increases, custom allograft composites are needed to match the premorbid anatomy. Baseplate composite structural allografts are used in patients with eccentric and centric defects to restore the glenoid joint line. Preserving bone stock is important in younger patients where a revision surgery is expected. The aim of this article is to present the assessment, planning, and indications of femoral head allografting for bony defects of the glenoid. Methods: The preoperative surgical planning and the surgical technique to execute the plan with a baseplate composite graft are detailed. The preliminary clinical and radiological results of 29 shoulders which have undergone this graft planning and surgical technique are discussed. Clinical outcomes included visual analogue score of pain (VAS), American Shoulder and Elbow Surgeons score (ASES), Constant–Murley score (CS), satisfaction before and after operation, and active range of motion. Radiological outcomes included graft healing and presence of osteolysis or loosening. Results: The use of composite grafts in this series has shown excellent clinical outcomes, with an overall graft complication rate in complex bone loss cases of 8%. Conclusion: Femoral head structural allografting is a valid and viable surgical option for glenoid bone defects in reverse shoulder arthroplasty. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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34 pages, 4150 KiB

Open AccessArticle

Impact of Deltoid Computer Tomography Image Data on the Accuracy of Machine Learning Predictions of Clinical Outcomes after Anatomic and Reverse Total Shoulder Arthroplasty

by Hamidreza Rajabzadeh-Oghaz, Vikas Kumar, David B. Berry, Anshu Singh, Bradley S. Schoch, William R. Aibinder, Bruno Gobbato, Sandrine Polakovic, Josie Elwell and Christopher P. Roche

J. Clin. Med. 2024, 13(5), 1273; https://doi.org/10.3390/jcm13051273 - 23 Feb 2024

Cited by 2 | Viewed by 2273

Abstract

Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder arthroplasty in any statistically/scientifically relevant manner. Methods: Preoperative computer tomography (CT) images from 1057 patients (585 female, 469 male; 799 primary rTSA and 258 primary aTSA) of a single platform shoulder arthroplasty prosthesis (Equinoxe; Exactech, Inc., Gainesville, FL) were analyzed in this study. A machine learning (ML) framework was used to segment the deltoid muscle for 1057 patients and quantify 15 different muscle characteristics, including volumetric (size, shape, etc.) and intensity-based Hounsfield (HU) measurements. These deltoid measurements were correlated to postoperative clinical outcomes and utilized as inputs to train/test ML algorithms used to predict postoperative outcomes at multiple postoperative timepoints (1 year, 2–3 years, and 3–5 years) for aTSA and rTSA. Results: Numerous deltoid muscle measurements were demonstrated to significantly vary with age, gender, prosthesis type, and CT image kernel; notably, normalized deltoid volume and deltoid fatty infiltration were demonstrated to be relevant to preoperative and postoperative clinical outcomes after aTSA and rTSA. Incorporating deltoid image data into the ML models improved clinical outcome prediction accuracy relative to ML algorithms without image data, particularly for the prediction of abduction and forward elevation after aTSA and rTSA. Analyzing ML feature importance facilitated rank-ordering of the deltoid image measurements relevant to aTSA and rTSA clinical outcomes. Specifically, we identified that deltoid shape flatness, normalized deltoid volume, deltoid voxel skewness, and deltoid shape sphericity were the most predictive image-based features used to predict clinical outcomes after aTSA and rTSA. Many of these deltoid measurements were found to be more predictive of aTSA and rTSA postoperative outcomes than patient demographic data, comorbidity data, and diagnosis data. Conclusions: While future work is required to further refine the ML models, which include additional shoulder muscles, like the rotator cuff, our results show promise that the developed ML framework can be used to evolve traditional CT-based preoperative planning software into an evidence-based ML clinical decision support tool. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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10 pages, 235 KiB

Open AccessArticle

Two-Stage Exchange Arthroplasty for Periprosthetic Reverse Shoulder Arthroplasty Infection Provides Comparable Functional Outcomes to Primary Reverse Shoulder Arthroplasty

by Maristella Francesca Saccomanno, Alexandre Lädermann and Philippe Collin

J. Clin. Med. 2024, 13(3), 904; https://doi.org/10.3390/jcm13030904 - 4 Feb 2024

Cited by 2 | Viewed by 1319

Abstract

This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group of patients who were treated electively with RSA without developing any complications. Out of 1477 RSAs performed between 2009 and 2021, 16 patients developed a PJI. Each matched cohort comprised 16 patients (3 females, 13 males). The mean age was 69.13 ± 5.43 years old in the PJI group and 70.28 ± 5.04 (p = 0.543) in the matched cohort. The mean follow-up was 41.23 ± 26.9 months in the PJI group and 28.5 ± 20.2 (p = 0.142) in the matched group. Only one patient showed recurrent PJI five years after revision RSA. Comparison between the PJI patients and matched patients did not show any significant differences at the latest follow-up, nor for subjective shoulder value (SSV) (p = 0.101) or Constant score (p = 0.134). Two-stage exchange RSA for PJI allows for appropriate control of the disease and good functional outcomes. Comparison with an age- and sex-matched cohort of uninfected patients showed no significant differences, thus confirming the idea that revision surgeries may lead to satisfactory functional outcomes, as expected after primary surgery. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

Review

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11 pages, 1028 KiB

Open AccessReview

Current Concepts in Shoulder Periprosthetic Joint Infections—Are Shoulders the Same as Hips and Knees?

by Florian August Frank, Andreas Marc Müller, Mario Morgenstern, Richard Kuehl and Martin Clauss

J. Clin. Med. 2025, 14(8), 2578; https://doi.org/10.3390/jcm14082578 - 9 Apr 2025

Viewed by 304

Abstract

Background/Objectives: The vast amount of research and data on periprosthetic joint infection (PJI) is focussed on infections in hip and knee replacements. This article aims to highlight the special features of PJI in shoulders. Methods: This narrative review is based on the recent and most relevant literature regarding PJI in general, and in shoulders in particular. Results: While the majority of findings for PJI in hips and knees can be transferred to infected shoulder arthroplasties, shoulder PJI represents a unique entity with a different microbial profile and its own diagnostic challenges. Conclusions: As profound evidence for shoulder PJI is lacking, diagnostic and therapeutic algorithms should be transferred from those for PJI in hips and knees. Further research is necessary to determine optimal management of shoulder PJI. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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10 pages, 764 KiB

Open AccessReview

Development, Evolution, and Outcomes of More Anatomical Reverse Shoulder Arthroplasty

by Pablo Sanchez-Urgelles, Logan Kolakowski, Jay M. Levin and Mark A. Frankle

J. Clin. Med. 2024, 13(21), 6513; https://doi.org/10.3390/jcm13216513 - 30 Oct 2024

Viewed by 974

Abstract

Reverse shoulder arthroplasty (RSA) has become a widely used procedure since its introduction in the 1980s, and is currently used to treat a wider range of conditions than its original indication. The original Grammont-style RSA revolutionized shoulder arthroplasty but had several limitations, including scapular notching and reduced rotational motion. This review discusses the evolution of RSA design, particularly the development of a lateralized center of rotation constructs, which aims to improve all the disadvantages associated with the Grammont-style design and more closely reproduce the native anatomy in order to improve patient outcomes in an expanded context of pathologies. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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Other

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24 pages, 6649 KiB

Open AccessSystematic Review

Allograft Prosthetic Composite (APC) for Proximal Humeral Bone Deficiency in Revision Reverse Shoulder Arthroplasty: A Technical Note and Systematic Review

by Hean Wu Kang, Christopher Child, Kristine Italia, Mirek Karel, Luke Gilliland, Helen Ingoe, Jashint Maharaj, Sarah Whitehouse, Kenneth Cutbush and Ashish Gupta

J. Clin. Med. 2024, 13(20), 6290; https://doi.org/10.3390/jcm13206290 - 21 Oct 2024

Viewed by 2009

Abstract

Background: Proximal humeral bone deficiency in revision shoulder arthroplasty is an emerging and challenging problem as the use of reverse shoulder arthroplasty (RSA) increases. This paper presents a technical note discussing our detailed preoperative planning steps, surgical techniques, and their rationale in carrying out the use of an allograft prosthetic composite (APC) to address proximal humeral bone deficiency in revision RSA. The outcomes of this technique are also presented. This paper also presents a systematic review to further discuss the existing literature on RSA with APCs. Methods: The preoperative surgical planning and the surgical technique employed to execute proximal humeral reconstruction using APC during revision arthroplasty are discussed in the technical note. The preliminary clinical and radiological results of five patients who underwent revision shoulder arthroplasty with proximal humeral reconstruction using APCs are presented. The PRISMA guidelines were followed to perform the systematic review. A systematic search using PubMed, Embase, and Cochrane databases was conducted. All studies involving RSA and APCs were pooled, and the data were extracted and analyzed. Results: A total of 14 studies were eligible for inclusion in the systematic review, with a total of 255 patients and a mean follow-up of 57 months. All studies in the systematic review and the patients included in the author’s case series showed improvements in the level of pain, range of motion, function, and satisfaction. Graft incorporation in the systematic review was 84%. Conclusions: Based on the available literature and the results of our case series, the use of an APC construct is a viable option for proximal humeral bone deficiency in revision shoulder arthroplasty. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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