Revision of Cemented Reverse Total Shoulder Arthroplasty with Bone Graft in Osteogenesis Imperfecta: A Case Report.

Introduction: Reverse total shoulder arthroplasty (RTSA) has many indications, including acute proximal humerus fracture or nonunion of such a fracture. However, we are unaware of any reports of the use of RTSA to treat proximal humerus fractures in patients with osteogenesis imperfecta (OI). Case Report: Here, we describe the challenges of RTSA for fracture nonunion in a 67-year-old woman with OI. The humeral component of the prosthesis loosened, and aspiration revealed 2 organisms. She underwent placement of an antibiotic spacer, after which cultures were negative. A second revision was then performed, during which a cemented proximal humeral component was implanted as part of the RTSA system. Subsequently, she fell, fracturing the humerus, which was treated with internal fixation with plates reinforced with a fibular allograft. The RTSA humeral component subsequently loosened, and she was revised to an allograft prosthetic composite. She subsequently healed but died after a fall in her home. Conclusion: Prompt identification and management of complications are crucial for improving outcomes of RTSA in patients with OI.