case_images: PMC10771046_01
case_images: Antero-posterior radiographs showing dislodgment of the glenoid component (A), and the intra-operative findings with PE wear (B).
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case_images: Two years later, in September 2020, the patient underwent the first revision surgery due to a dislodged glenosphere from the metaglene component (Figure 1).
case_images: Axillary view of the dislocated RSA.
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case_images: Plain radiographs showed antero-inferior dislocation of the left RSA (Figure 2).
case_images: Prosthetic components were removed during the first phase of the 2-stage revision procedure (A), and a preformed antibiotic loaded spacer has been implanted (B). Note the version defect filled with bone cement.
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case_images: An antibiotic-loaded spacer was then implanted and an excessive humeral component anteversion was detected (Figure 3).
case_images: The pre-operative 3D CT-based planning highlighted a severe combined glenoid bone loss, shown on the 3 planes of space: (A) sagittal, (B) coronal, and (C) transverse.
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case_images: A CT scan with 3D reconstruction was performed to gain a clearer understanding of the altered patient's anatomy (Figure 4).
case_images: Customized baseplate (A) and PSI required to its implant (B). A 3D-model of the patient's scapula was obtained with a 3D-printer to verify the correspondence between patient's anatomy and the customized implant.
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case_images: Moreover, given the complexity of the case, an intra-operative navigation system (GPS Navigation System, Exactech, Gainesville, FL, USA) was deployed to adhere to pre-operative planning and prevent component malpositioning or incorrect fixation (Figure 5).
case_images: Intra-operative computer-assisted navigation for the central peg's (A) and screws' (B) holes have the aim to support the surgeon during operation giving real-time feedback on the position of the drill.
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case_images: As regards the humeral side, a cemented Equinoxe  Reverse Shoulder System stem (Exactech, Gainesville, FL, USA) size 13 mm with 25  retroversion was implanted (Figure 6).
case_images: Antero-posterior radiographs obtained at 1-year follow-up showing a stable prosthesis.
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case_images: At 1-year follow-up, the patient presented with no signs of local infection nor pain, a stable prosthesis (Figure 7) and a good shoulder ROM (80  abduction, 70  anterior elevation, 15  external rotation, and hand to the buttock in internal rotation).