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Comparative Study
. 2026 Jan 13;21(1):108.
doi: 10.1186/s13018-025-06632-z.

Reverse total shoulder arthroplasty in neglected anterior shoulder dislocation with glenoid bone defect: a comparative cohort study

Chieh-An Chuang  1   2   3 , Huan Sheu  2   3   4 , You-Hung Cheng  2   3   5 , Cheng-Pang Yang  2   3   4 , Hao-Che Tang  1   2   3 , Chen-Heng Hsu  2   3   4 , Kuo-Yao Hsu  2   3   5 , Alvin Chao-Yu Chen  2   3   4 , Joe Chih-Hao Chiu  6   7   8   9
Affiliations
Comparative Study

Reverse total shoulder arthroplasty in neglected anterior shoulder dislocation with glenoid bone defect: a comparative cohort study

Chieh-An Chuang et al. J Orthop Surg Res. .

Abstract

Aims: Literature has reported favorable outcomes of reverse total shoulder arthroplasty (RSA) for treating neglected anterior shoulder dislocation (NASD). However, few studies have specifically addressed the treatment outcomes and management of NASD in the presence of glenoid bone loss. The aim of this study is to evaluate the clinical outcomes of RSA in patients with NASD associated with glenoid bone defects.

Methods: We conducted a retrospective cohort study of NASD patients treated with RSA from January 2018 to December 2022. Neglected dislocation was defined as lasting more than three weeks. Glenoid bone defect size and patient demographics were recorded. A matched control group of patients who underwent RSA for classical indications was included. NASD patients were divided into those who received autologous bone grafting (BG) and those who did not (N-BG). Outcome measures included range of motion (ROM), visual analogue scale (VAS) for pain, subjective shoulder value (SSV), Constant score (CS), and American Shoulder and Elbow Surgeons (ASES) score.

Results: Twenty-four NASD patients (mean duration 3.0 ± 1.3 months) were included, with an average glenoid defect of 25.3 ± 8.5%. Eleven underwent bone grafting due to defect sizes ≥ 30%. Compared to cuff tear arthropathy patients, NASD patients had worse preoperative ROM and functional scores. At final follow-up, the NASD group demonstrated marked postoperative improvements in forward flexion (from 44.7° to 121.3°), external rotation (from 2.2° to 26.9°), and abduction (from 57.8° to 95.9°). Functional outcomes were comparable between the NASD group and the matched cuff tear arthropathy group, with VAS scores of 1.4 vs. 1.2 (p = 0.370) and CS, SSV, and ASES scores of 75.2 vs. 77.4 (p = 0.290), 80.3 vs 81.3 (p = 0.751), and 77.6 vs. 80.4 (p = 0.165), respectively. Similarly, no significant differences were observed between the BG and N-BG groups, with VAS scores of 1.6 vs. 1.2 (p = 0.187) and CS, SSV, and ASES scores of 74.4 vs. 75.8 (p = 0.730), 81.4 vs. 79.4 (p = 0.692), and 76.6 vs. 78.4 (p = 0.585), respectively.

Conclusion: RSA is effective for NASD with glenoid bone loss, yielding outcomes comparable to cuff tear arthropathy cases. Bone grafting for defects ≥ 30% provided favorable results without significant differences in functional recovery compared to non-grafted cases.

Keywords: Bone grafting; Glenoid bone defect; Neglected anterior shoulder dislocation; Reverse total shoulder arthroplasty.

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Conflict of interest statement

Declarations. Competing interests: The authors have no conflicts of interest to declare that are relevant to the content of this article. Ethics approval and consent for publication: This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Chang Gung Memorial hospital approved this study (No. 202400326B0). Patients signed informed consent regarding publishing their data and photographs. All the authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Institutional Review Board name/number: Chang Gung Medical Foundation Institutional Review Board/202400326B0

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment
Fig. 2
Fig. 2
Preoperative x-ray of one 66 years-old female with right side neglected anterior shoulder dislocation noted for eight weeks
Fig. 3
Fig. 3
Glenoid bone defect presented by 3D-CT and the demonstration of ideal central screw drill pin, central screw and baseplate position. a Blue circle: Best circle of glenoid; Brown Dot: Center of the best circle/Position for drill pin; Orange line: Distance between posterior glenoid and position for central drill pin. b Green circle: Baseplate position; White circle: Central screw position; Brown Dot: Center of the best circle
Fig. 4
Fig. 4
Demonstration of bone grafting during RSA surgery. a Wedge-shaped bone graft harvested from resected humeral head. b Bone graft fixation to the glenoid bone defect with one cancellous screw
Fig. 5
Fig. 5
Example of postoperative x-ray 2 year after the reverse total shoulder arthroplasty with glenoid bone grafting augmentation for neglected shoulder anterior dislocation
Fig. 6
Fig. 6
NASD vs N-NASD preoperative and postoperative outcomes
Fig. 7
Fig. 7
BG vs N-BG preoperative and postoperative outcomes
See this image and copyright information in PMC

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