A Sequential Approach to the Management of Posterior Glenoid Defects in RSA

Large posterior glenoid defects pose problems in reverse shoulder arthroplasty (RSA). We have adopted a sequential approach to the management of posterior glenoid defects using asymmetrical reaming, the placement of a ring graft around the central peg (bony-increased offset, or BIO), or structural bone-grafting, depending on the amount of glenoid retroversion. Furthermore, we have devised multiple bioresorbable pinning (MBP)-assisted bone-grafting, in which as many bioresorbable pins as required are inserted, from whichever aspects of the graft necessary, to achieve initial stability.