Addressing glenoid bone loss during shoulder arthroplasty is a challenge. Factors such as patient age, glenoid vault anatomy, rotator cuff status, and inflammatory arthritis influence surgical decision making. Bone grafting and metal augmentation are two strategies that can be used to address glenoid vault deficiency. This video demonstrates reverse shoulder arthroplasty and structural bone grafting for the management of glenoid vault deficiency in patients with inflammatory arthropathy. Performing reverse shoulder arthroplasty and bone grafting with the use of autograft or allograft is beneficial in patients with a massively deficient glenoid vault because it restores bone stock and glenoid anatomy. The use of a central screw to fix the glenoid baseplate to the graft and paleoglenoid is paramount to ensure adequate compression and subsequent bony incorporation.

This video demonstrates the technique for bone grafting a massively deficient glenoid vault during reverse total shoulder arthroplasty in an active 72-year-old woman with inflammatory arthropathy, a type B3 glenoid, a rotator cuff lag sign, and pseudoparalysis. The senior author used this surgical technique in seven patients, all of whom regained full shoulder motion, returned to work or activity by 6 months postoperatively, and experienced no graft or prosthesis failure. The video highlights the pertinent aspects of the technique and reviews the rationale for the approach. Reconstruction of a massively deficient glenoid vault with the use of structural autograft is not only appealing but may be preferred to avoid the costs associated with custom metal augments. Currently, a paucity of high-level evidence exists comparing structural bone grafting with metal reconstruction and augmentation for the management of glenoid vault deficiency. The procedure described in this video is reproducible and involves the use of central screw and peripheral screw compression principles to create a stable fixation construct that restores glenoid vault anatomy, resulting in pain relief and functional motion in patients with a massively deficient glenoid vault and deficient rotator cuff.