Clinical outcomes of augmented baseplates in reverse total shoulder arthroplasty: a systematic review

Abstract

Background

Reverse total shoulder arthroplasty (rTSA) is a widely accepted treatment for rotator cuff arthropathy and complex glenohumeral arthritis. However, managing severe glenoid wear, particularly with retroversion, superior inclination, or bone loss, remains a challenge. Augmented baseplates offer a promising solution by improving fixation strength and maintaining bone stock without excessive bone removal or grafting. This systematic review evaluates the clinical, radiographic, and functional outcomes of augmented baseplates in rTSA compared to conventional techniques, including standard baseplates and, where available, bone grafting.

Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ovid MEDLINE, EMBASE, and PubMed databases were searched from inception to October 2024 for studies evaluating augmented baseplates in rTSA. Inclusion criteria included clinical studies with ≥10 patients, a minimum 12-month follow-up, and documented functional, radiographic, and complication outcomes. Data extraction included demographics, implant type, functional scores, range of motion, and complication rates.

Results

Eight studies with 837 patients were included. The mean follow-up was 38.5 months. Augmented baseplates demonstrated significant improvements in forward elevation (+53°), abduction (+47°), and external rotation (+19°). Functional scores improved significantly, with pooled increases in American Shoulder and Elbow Surgeons Shoulder Score (+45.9), Constant (+33.7), and University of California Los Angeles (+16.9) scores. The overall complication rate was 5.9%, including baseplate loosening (1.2%), instability (0.8%), and acromial stress fractures (1.0%). Pooled outcomes demonstrated moderate heterogeneity (I² values ranging from 31% to 52%).

Conclusion

Augmented baseplates in rTSA provide effective correction of glenoid deformities while minimizing bone loss and surgical complexity. They may offer improved functional outcomes, reduced complication rates, and reliable fixation compared to conventional techniques, making them an increasingly considered option.