Running Out of Room: Managing Humeral and Glenoid Bone Loss in Shoulder Arthroplasty.

Glenoid bone loss is frequently encountered in arthritic conditions. The Walch classification is commonly used to categorize glenoid bone loss into several different types. Preoperative CT can assist in identifying the type and extent of bone loss for development of the appropriate treatment plan. Restoration of glenoid alignment and soft-tissue balancing is essential in shoulder arthroplasty, which can be achieved through a variety of techniques including high side reaming, augmented components, and bone grafting. Reverse total shoulder arthroplasty, another viable option to address severe bone deficiency, may be performed in conjugation with bone grafting or augmented components. Extensive bone loss may also be addressed in a staged procedure or avoided with isolated humeral head replacement. Humeral bone loss also remains a challenge in patients undergoing shoulder arthroplasty, which may be addressed with an allograft-prosthesis composite or an isolated metal prosthesis. Further investigation into the use of different biomaterials, ceramics, endosteal fixation, and modular components is needed. There are promising results with computer-assisted component implantation.