Reverse Total Shoulder Arthroplasty with Total Humeral Head Autograft Surgical Technique for Subtotal Glenoid Bone Loss

Background:Severe glenoid bone loss presents a significant challenge when considering shoulder arthroplasty options.When more than 90% of the normal glenoid vault is eroded, most surgical algorithms favor custom made implants with inherent time delay and added expense.Reverse total shoulder arthroplasty (RTSA) combined with Total Humeral Head Autograft (THHA) is proposed as an alternative solution. Methods:A patient with subtotal glenoid bone loss due to erosive osteoarthritis underwent RTSA with Total Humeral Head Autograft.Pre-operative planning involved x-ray imaging and CT scans to evaluate the bone loss pattern.The center of rotation was significantly medialized at the level of the coracoid base.The surgical technique included harvesting the humeral head autograft with an anatomic neck osteotomy and preparing the glenoid surface by minimal decortication.The graft was primarily fixed to the glenoid vault remnant with the central metaglene screw inserted into the trifurcation bone corridor between the coracoid, scapula spine and scapula blade.Four peripheral screws passed through the THHA into the glenoid shell.The remaining RTSA components were then implanted, and post-operative imaging was performed to assess graft integration and component positioning.Follow-up imaging and clinical evaluation were performed to monitor outcomes. Results: J o u r n a l P r e -p r o o fThe patient demonstrated graft integration with stable fixation, as confirmed by post-operative CT and X-ray images.The patient sustained a scapular body fracture eight weeks postoperatively; however, the RTSA construct remained stable and well positioned.Functional outcomes included improvement in range of motion (145 degrees flexion, 145 degrees abduction, 70 degrees external rotation), significant reduction in pain (0/10), and enhanced shoulder function.No complications, such as graft resorption or implant loosening, were observed during 12-month follow-up. Conclusions:Reverse total shoulder arthroplasty with total humeral head autograft provides an effective surgical option for managing severe end-stage cavitatory glenoid bone loss.This technique allows for viable reconstruction of glenoid bone stock and favorable short-term clinical outcomes while re-establishing a more anatomic center of rotation.The technique may be useful in resource-poor environments where advanced technology or tools are not required.Further studies with larger patient cohorts are needed to confirm long-term efficacy.