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. 2025 Oct 8:S1058-2746(25)00700-1.
doi: 10.1016/j.jse.2025.08.017. Online ahead of print.

Surgical and Patient Factors Associated with Baseplate Failures After Reverse Shoulder Arthroplasty: A Study by the ASES Complications of RSA Multicenter Research Group

ASES Complications of RSA Research Group; Adam Bowler  1 , Evan A Glass  1 , Jason Corban  1 , Declan R Diestel  1 , Miranda McDonald-Stahl  1 , Calista S Stevens  2 , Regan P Arnold  1 , Himmat Sahi  3 , Richard Puzzitiello  3 , Daniel P Swanson  1 , Michael A Moverman  3 , Ryan Lohre  4 , Kuhan A Mahendraraj  1 , Kiet Le  1 , Warren R Dunn  5 , Dylan J Cannon  6 , Hunter Carlson  7 , Peter J Chabot  8 , Charles Cogan  9 , Matthew R Colatruglio  10 , Lisa G M Friedman  11 , Jaina A Gaudette  11 , John Green  12 , Lauren Grobaty  9 , Michael Gutman  13 , Jason C Ho  9 , Keegan Hones  14 , Ermyas Kahsai  15 , Jacquelyn Kakalecik  14 , Mitchell Kirkham  7 , Michael A Kloby  16 , Elliot N Konrade  10 , Margaret C Knack  10 , Tyler LaMonica  14 , Amy Loveland  17 , Joshua I Mathew  8 , Emma Merrill  7 , Albert D Mousad  18 , Luke Myhre  7 , Andrew Nahr  10 , Jacob Nyfeler  7 , Doug E Parsell  19 , Midhat Patel  9 , Marissa Pazik  14 , Teja S Polisetty  6 , Padmavathi Ponnuru  20 , John Scanaliato  11 , Arden Shen  11 , Karch M Smith  7 , Katherine A Sprengel  11 , Ocean Thakar  17 , Lacie Turnbull  14 , Alayna Vaughan  13 , John C Wheelwright  7 , Anastasia Whitson  15 , Anna B Williams  8 , Tyler Williams  11 , Joseph Abboud  13 , April Armstrong  20 , Luke Austin  13 , Tyler Brolin  10 , Vahid Entezari  9 , Grant E Garrigues  11 , Brian Grawe  16 , Lawrence V Gulotta  8 , Rhett Hobgood  19 , John G Horneff  21 , Joseph Iannotti  9 , Jason E Hsu  15 , Michael Khazzam  22 , Joseph J King  14 , Jacob M Kirsch  1 , Jonathan C Levy  18 , Anand Murthi  17 , Surena Namdari  13 , Gregory P Nicholson  11 , Randall J Otto  12 , Eric T Ricchetti  9 , Robert Z Tashjian  7 , Thomas Throckmorton  10 , Thomas Wright  14 , Andrew Jawa  23
Affiliations

Surgical and Patient Factors Associated with Baseplate Failures After Reverse Shoulder Arthroplasty: A Study by the ASES Complications of RSA Multicenter Research Group

ASES Complications of RSA Research Group et al. J Shoulder Elbow Surg. .

Abstract

Background: Baseplate failure is a rare but serious complication following reverse shoulder arthroplasty (rTSA), often leading to poor outcomes and revision surgery. Existing studies are limited by small samples or single-center designs. This multicenter study aimed to identify surgical, implant, and patient-related risk factors for baseplate failure after rTSA.

Methods: A multicenter, retrospective study was conducted across 15 U.S. institutions involving 24 ASES surgeons. Patients who underwent rTSA from June 2013 to May 2019 with a minimum 3-month follow-up were included. Study parameters were established using the Delphi method. Patients with confirmed baseplate failure were compared to those without using univariate and multivariable logistic regression analyses. Failure was defined radiographically as gross baseplate shift or hardware breakage.

Results: Among 5,049 cases, 83 (1.6%) experienced baseplate failure at a median of 72 weeks post-surgery. Most failures (76%) were atraumatic; 12% were traumatic, and 12% had an unknown mechanism. Radiographs showed hardware breakage in 68.7% of failures-33.3% involved central screw/post fractures and 86.0% involved peripheral screw fractures. Baseplate shift occurred in 78.3% of cases. Independent predictors of failure included revision arthroplasty (OR 4.57; P < .001), use of bone graft (OR 2.81; P < .001), and total glenoid-sided lateral offset (OR 1.08; P = .002). Central screw fixation reduced failure risk (OR 0.55; P = .014). In primary rTSA, bone grafting (OR 4.42; P < .001) and lateral offset (OR 1.07; P = .046) were significant predictors. In revision rTSA, only bone grafting remained significant (OR 3.75; P < .001). Allograft use led to higher failure rates than autograft (14.7% vs. 3.9%; P = 0.001).

Conclusion: Revision surgery, bone grafting (especially allografts), and increased lateral offset were significantly associated with higher odds of baseplate failure after rTSA. Central screw fixation appears protective. Most failures were atraumatic, underscoring the importance of achieving stable bone ingrowth. These findings may inform surgical planning and patient counseling regarding factors associated with increased failure risk.

Keywords: baseplate failure; hardware; implant; multicenter; reverse shoulder arthroplasty; risk factors.

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