02/13/2026
When hiking the wrong way, it’s best to restart the journey on the correct path. This surgery was just like that.
The patient presented after multiple prior failed surgeries including an infection with MRSA (previously revised/treated). The initial x-rays demonstrated a superiorly tilted baseplate and a proud stem. The patient had generally preserved function but had ongoing pain. Due to this pain, concern for polyethylene wear, and concern for indolent recurrent infection, surgery was recommended. I proceeded with a 2-stage revision plan. During surgery, the shoulder had inflammatory tissue that was concerning for infection and also polyethylene wear disease. A functional antibiotic spacer was placed because of the concern for recurrent infection. Surgical cultures were negative. The 2nd stage revision was 5 months after my first surgery. Severe glenoid bone loss was identified on the 3D revision preop plan seen here. The glenoid was revised with a 29 mm full wedge augmented baseplate with a central post in a more superior baseplate position because the host bone stock offered solid post fixation. A 42 mm eccentric inferior glenosphere was then used to optimize the center of rotation and avoid inferior bony impingement and scapular notching. I used a modular diaphyseal fixation stem with a proximal tuberosity replacing body to avoid stress on the overall humeral construct & optimize the deltoid wrapping effect. The patient is in early follow-up and is progressing well. Surgical cultures from the second stage surgery were also negative. When revising shoulders that have been treated with multiple prior surgeries, managing complex bone loss can be challenging both for the humerus and the glenoid reconstruction. 3D preoperative planning in the revision setting helps me plan viable reconstruction options and understand when bone grafting or augmented implants will be needed. How would you proceed with his reconstruction?