Citation

Merolla G, De Filippo F, Magrini Pasquinelli F, et al.
Primary and Revision Reverse Shoulder Arthroplasty Using Custom-Made 3D-Printed Baseplates for Severe Multiplanar Glenoid Bone Defects: A Retrospective Study of Clinical and Radiographic Outcomes.
J Clin Med. 2025.
PMID: 40943913
PMCID: PMC12429269

🔗 Read the full article on PubMed:
https://pubmed.ncbi.nlm.nih.gov/40943913/

Opening Editorial: Editor’s Perspective

Severe glenoid bone loss remains one of the most technically demanding challenges in shoulder arthroplasty.

Standard implants often struggle to achieve stable fixation in cases involving:

• Multiplanar defects

• Revision settings

• Poor bone stock

Advances in 3D imaging and additive manufacturing have introduced custom-made glenoid components designed to match patient-specific anatomy.

This issue of Conversations in Orthopaedics explores a recent retrospective multicenter study evaluating clinical and radiographic outcomes of custom 3D-printed glenoid implants in both primary and revision reverse shoulder arthroplasty (RSA).

Why This Paper Matters

As the number of primary shoulder arthroplasties increases, revision cases, often complicated by bone loss, are becoming more common.

Traditional solutions such as:

• Bone grafting

• Eccentric reaming

• Offset designs

have shown inconsistent results in severe defects.

Custom implants offer a new approach:

- Instead of adapting the anatomy to the implant,
- The implant is adapted to the anatomy.

Study Overview

This was a multicenter retrospective study involving:

• 23 shoulders

• 11 primary RSA cases

• 12 revision RSA cases

• Minimum follow-up: 24 months

Custom implants were created using:

• CT-based 3D modeling

• Finite element analysis

• Patient-specific instrumentation

Outcomes assessed included:

• Range of motion

• Pain relief

• Constant–Murley scores

• Radiographic stability

Key Findings

1. Functional Improvement

Both primary and revision groups demonstrated significant improvement in:

• Mobility

• Pain

• Constant–Murley scores (p < 0.001)

Importantly, outcome improvements were similar between primary and revision settings.

2. Implant Stability

Radiographically:

• No loosening was observed

• Minimal radiolucent lines were noted

Suggesting reliable fixation despite severe bone loss.

3. Complications

Instability occurred in:

• 4 revision cases

• Only 1 required conversion to hemiarthroplasty

Overall complication rates remained low.

Strengths of the Study

The study demonstrates that:

Custom implants can:

• Address complex anatomy

• Improve functional outcomes

• Provide stable fixation

even in revision scenarios.

This is significant, as revision RSA traditionally carries worse outcomes.

Limitations

The authors appropriately caution that:

• The sample size was small

• Follow-up duration was limited

• Retrospective design introduces bias

Further prospective studies are needed to confirm long-term durability and cost-effectiveness.

Broader Perspective

Custom implants represent a shift in orthopaedic philosophy:

From standardized solutions
- To patient-specific reconstruction

However, they also raise important questions:

• Are improved outcomes driven by design or selection?

• Do benefits justify higher costs?

• Will scalability remain a challenge?

Closing Perspective

Custom-made glenoid implants appear to offer a promising solution for severe bone loss in both primary and revision RSA.

But as with many emerging technologies in orthopaedics, the path from innovation to standard of care will depend on:

• Larger cohorts

• Long-term follow-up

• Cost-effectiveness data

Precision is improving.

The evidence is still evolving.

Discussion Questions

1. Should custom implants be considered earlier in complex primary RSA cases?

2. How should cost influence the adoption of patient-specific solutions?

3. Can personalization meaningfully reduce revision risk?

   Thanks for reading! Subscribe for free to receive new posts and support my work.