Customized glenoid implants in reverse total shoulder arthroplasty: assessing revision rate and causes of failure in the Australian Joint Registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Severe bone loss presents as a challenge for surgeons during a reverse total shoulder arthroplasty (rTSA). Customized three-dimensional–printed glenoid implants have been developed to address complex deformities, but comparative data on their survivorship remain limited. This study examined demographics, revision rates and causes in patients undergoing primary or revision rTSA using custom three-dimensional–printed glenoid components compared to standard implants. Methods This was a retrospective national registry study of patients undergoing primary and revision rTSA. Cohorts were defined as (1) primary rTSA and (2) first revision rTSA, each stratified by use of either custom glenoid implants (primarily Zimmer-Biomet and Lima/Enovis) or standard prostheses. Revision was analyzed using Kaplan–Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazard models, adjusting for age and gender. The reasons for revision were compared as a secondary outcome measure. Patient-reported outcome measures were not analyzed. Results Of 49,230 primary rTSA and 1,597 first revision rTSA, there were 157 primary and 31 first revision custom rTSA procedures. The cumulative percent revision for primary custom rTSA was 7.1% (95% confidence interval 3.8–13.2) at 4 years. Following first revision rTSA using a custom glenoid, the cumulative percent revision for second revision was 21.0% (95% confidence interval 9.0–46.0) at 5 years. The custom rTSA group had a higher rate of revision compared to standard implants (HR = 1.84 [1.02, 3.33], P = .043), whereas no statistically significant difference was observed in the revision setting (HR = 1.15 [0.48, 2.80], P = .750) or when restricted to patients with more severe deformity (Walch morphology type C) (HR = 1.92 [0.68, 5.42], P = .219). The causes of revision tended to be consistent between groups, being instability/dislocation (n = 4 [36.4%] vs. n=600 [32.6%]), infection, and loosening (n = 3 [27.3%] vs. n=300 [16.3%]), noting that statistical comparison was limited by small numbers in the custom cohort. Conclusion In this national registry study, customized glenoid implants in primary rTSA showed a higher overall revision rate than standard implants, but this appears driven by case complexity: customized implants were predominantly used for severe deformity (notably Walch C). When analysis was limited to Walch C glenoids, revision risk was not significantly different between customized and standard implants. Failure modes were similar across groups—instability/dislocation, loosening, and infection were the leading causes—and second revision rates after revision rTSA did not differ, acknowledging small numbers. Further case-matched studies with better deformity quantification and patient-reported outcome measures are needed to define optimal indications and long-term value of customized implants.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W7214746480