Current concepts and treatment options for complex glenoid bone defects : Patient-specific instrumentation and custom-made implants

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Glenoid bone defects are frequent and the etiology is multifactorial. To prevent increased loosening rates of the glenoid component in total shoulder arthroplasty (TSA), various techniques are available to address the loss of glenoid bone. When corrective reaming and bone grafting techniques are no longer sufficient, patient-specific instrumentation (PSI) and custom-made implants have become core strategies for managing these defects. Following precise planning based on computed tomography (CT) imaging and three-dimensional reconstruction of the bony surface, an individualized guide can be used to accurately position the implant. When the limits of bone reconstruction have been reached, specially prepared (custom-made) implants can be used to compensate for the bony defect. Patients often require minimal postoperative immobilization of the shoulder joint. The currently limited literature describes favorable clinical outcomes, although these findings are almost exclusively limited to reverse shoulder arthroplasty.