Pre-operative planning for reverse shoulder replacement: the surgical benefits and their clinical translation

With the increasing use of reverse shoulder arthroplasty and its expanding indications, surgeons today are facing tougher reconstructive challenges while still providing the patient with a good clinical outcome. There are a greater number of primary and revision cases where glenoid vault deformity is encountered. This presents a challenge to the surgeon during glenoid component positioning. He or she must place the implants in a location and orientation that optimizes range of motion and stability while minimizing impingement. In order to address this, surgeons can look to the use of 3D imaging in order to better understand each patient’s pathology. With the use of virtual planning the surgeon has the ability to arrive in the operating room with an established surgical plan in order to better address the deformity present. This can help in determining if glenoid bone grafting, eccentric reaming, or the use of augmented/lateralized components is the best choice in addressing bony deformity and maximizing impingement-free range-of-motion. Furthermore, with the advent of patient specific instrumentation and navigation the surgeon has the means to translate the preoperative plan into the operating room with increased accuracy, thus, decreasing the likelihood of component malposition and its associated complications. In the future, custom implants may grant the surgeon the means to address severe glenoid bone loss that would otherwise not be reconstructable and potentially give the patient improved function.