Customized glenoid implants in reverse total shoulder arthroplasty: assessing revision rate and causes of failure in the Australian Joint Registry
5 affiliations
- 1Faculty of Medicine, Nursing, and Midwifery, and Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
- 2Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
- 3School of Surgery, University of Western Australia, Perth, WA, Australia
- 4South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- 5Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
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.
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BibTeX
@article{banks2026customized,
title = {{Customized glenoid implants in reverse total shoulder arthroplasty: assessing revision rate and causes of failure in the Australian Joint Registry}},
author = {Megan C. Banks and Stefan Bauer and Peiyao Du and David RJ. Gill and William G. Blakeney},
journal = {Journal of Shoulder and Elbow Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.jsea.2026.100098},
url = {https://doi.org/10.1016/j.jsea.2026.100098},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Customized glenoid implants in reverse total shoulder arthroplasty: assessing revision rate and causes of failure in the Australian Joint Registry
AU - Megan C. Banks
AU - Stefan Bauer
AU - Peiyao Du
AU - David RJ. Gill
AU - William G. Blakeney
PY - 2026
DA - 2026/09/29
JO - Journal of Shoulder and Elbow Arthroplasty
DO - 10.1016/j.jsea.2026.100098
UR - https://doi.org/10.1016/j.jsea.2026.100098
AB - 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.
SN - 2471-5492
ER -