Custom glenoid implants for revision shoulder arthroplasty

Custom glenoid implants are an option to manage severe glenoid bone deformity in the setting of reverse shoulder arthroplasty. These implants are most commonly used in revision arthroplasty cases and are indicated when severe glenoid deformity limits initial fixation strength. Shoulder CT scan evaluation is necessary for evaluating glenoid deformity and is the cornerstone for planning custom implants. Custom glenoid implants provide supplemental fixation not available in standard implant/bone graft constructs. One key feature is the fabrication of a metallic custom glenoid baseplate that matches the glenoid deformity thus maximizing baseplate to bone contact area. Alternative baseplate fixation points along the anterior vault, coracoid base, and scapular spine are also commonly used. Last, customized screw trajectories can be planned to maximize initial fixation construct strength. Early results of custom glenoid baseplates show promising clinical outcomes and radiographic survivorship; however, further research is needed to better define surgical indications and implant design features to maximize outcomes. Future advances in imaging, biomaterials, and instrumentation are likely in the near future given recent rapid advances in technology.