Reverse total shoulder arthroplasty (RSA) serves as an effective alternative to total shoulder arthroplasty (TSA), especially for patients with rotator cuff deficiency [1]. Long-term performance of RSA has been limited by a variety of complications including dislocation, infection, humeral fracture, glenoid loosening, glenoid unscrewing, scapular erosion and polyethylene debris [1–2]. Dissociation between the proximal metaphyseal component and distal humeral prosthetic stem (disaphysis) in modular RSAs has been reported with low frequency (1–2%) [2]; however, cases have led to severe consequences including in vivo disassembly [3]. Most cases of unscrewing have occurred due to insufficient support for the prosthesis resulting from proximal humeral bone deficiency [4–5]. In this study, we evaluate a retrieved RSA that unscrewed and subsequently fractured in vivo in a patient with proximal bone deficiency.

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