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A 67-year-old woman with proximal humerus fracture nonunion underwent RTSA-related revisions after prosthesis loosening and positive culture results, later requiring further fixation reinforced with fibular allograft after a fall. Subsequent loosening led to revision to an allograft prosthetic composite, with eventual healing but death following another fall.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/revision-of-cemented-reverse-total-shoulder-arthroplasty-with-bone-graft-in-osteogenesis-imperfecta-a-case-report/447441/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/revision-of-cemented-reverse-total-shoulder-arthroplasty-with-bone-graft-in-osteogenesis-imperfecta-a-case-report/447441.png","ImageObject",300,407,{"name":92,"@type":93},"LangkahRina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What learning point does the article emphasize for RTSA in osteogenesis imperfecta patients?","Question",{"text":113,"@type":114},"Shoulder arthroplasty in patients with osteogenesis imperfecta should be performed with full knowledge of possible complications.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why was a revision performed after the initial RTSA-related treatment?",{"text":118,"@type":114},"The humeral component loosened and aspiration revealed two organisms; an antibiotic spacer was placed when cultures were negative, followed by a second revision with a cemented proximal humeral component.",{"name":120,"@type":111,"acceptedAnswer":121},"What complications affected the patient’s postoperative course?",{"text":122,"@type":114},"After surgery, the patient fell and fractured the humerus, required internal fixation with plates reinforced with fibular allograft, later experienced loosening of the RTSA humeral component, and underwent revision to an allograft prosthetic composite.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},447441,1790765225,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962090893776,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Case Report  Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 89-95   \nRevision of Cemented Reverse Total Shoulder Arthroplasty with Bone Graftin Osteogenesis Imperfecta: A Case Report  \nJames H Padley1, HoeY Hor1, Eve R Glenn2, Necati B Eravsar1, Alexander R Zhu2,  \nEdward G McFarland1  \nLearning Point of the Article:  \nShoulder arthroplasty in patients with osteogenesis imperfecta should be performed with full knowledge of possible complications.  \nAbstract  \nIntroduction: 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).  \nCase Report: Here, we describe the challenges of RTSA for fracture nonunion ina 67-year-oldwoman with OI. The humeral component of the prosthesis loosened, and aspiration revealed 2 organisms. She underwent placement ofan antibioticspacer, 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 fallin her home.  \nConclusion: Prompt identification and management ofcomplications are crucial forimproving outcomes of RTSAin patientswith OI. Keywords: Allograft prosthetic composites, complications, fracture nonunion, osteogenesis imperfecta, reversetotal shoulder arthroplasty.  \nIntroduction  \nOsteogenesis imperfecta (OI), also known as “brittle bone disease,” isarare genetic disorder caused by abnormalities in type 1 collagen synthesis and affects approximately 1 in 15,000–20,000 births [1, 2]. OI is classified by clinical severity and genotype, with present nosology based on the original classification by Sillence et al. [1] The 4 traditional groups of OI are type I, the mildest form, dominantly inherited with bluesclerae and usually presenting at school age; type II, a lethal perinatal form characterized by crumpled femora and beaded ribs; type III, which is progressively deforming and the most  \nsevere survivable form; and type IV, a dominantlyinherited form with normal sclerae and moderate severity [3, 4, 5]. However, the classification of OI has been expanded to 8 types, incorporating cases with unidentified genetic defects and thosewith mutations in a gene affecting collagen type I hydroxylation [6, 7]. Patients with OI oftenpresent with bone fragility, leading to frequent lowenergy fractures that require surgical intervention. For patients with OI who undergo reverse total shoulder arthroplasty (RTSA), defective bone formation can present treatment challenges. The purpose of this case report is to describe difficulties and complications associated with the use of RTSAin  \n\n| \u003Cbr>Access this article online\u003Cbr>\u003Cbr>Website: [www.jocr.co.in](www.jocr.co.in)\u003Cbr>\u003Cbr>DOI:\u003Cbr>[https://doi.org/10.13107/jocr.2025.v15.i12.6464](https://doi.org/10.13107/jocr.2025.v15.i12.6464) | Author’s Photo Gallery |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n|  | | | | | | \u003Cbr>Dr. Edward G McFarland |\n|  | \u003Cbr>1Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, 2The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.\u003Cbr>Address of Correspondence:\u003Cbr>Dr. Edward G McFarland,\u003Cbr>Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. E-mail: [emcfarl1@jhmi.edu](emcfarl1@jhmi.edu) |  |  |  |  |  |\n| Submitted: 01/09/2025; Review: 22/10/2025; Accepted: November 2025; Published:","cbCaioXTZuC71HgB","https://ap.wps.com/l/cbCaioXTZuC71HgB","pdf",10209935,"English","# Learning Point of the Article\n# Abstract\n# Introduction\n# Case Report\n# Conclusion\n# Keywords","[{\"question\":\"What learning point does the article emphasize for RTSA in osteogenesis imperfecta patients?\",\"answer\":\"Shoulder arthroplasty in patients with osteogenesis imperfecta should be performed with full knowledge of possible complications.\"},{\"question\":\"Why was a revision performed after the initial RTSA-related treatment?\",\"answer\":\"The humeral component loosened and aspiration revealed two organisms; an antibiotic spacer was placed when cultures were negative, followed by a second revision with a cemented proximal humeral component.\"},{\"question\":\"What complications affected the patient’s postoperative course?\",\"answer\":\"After surgery, the patient fell and fractured the humerus, required internal fixation with plates reinforced with fibular allograft, later experienced loosening of the RTSA humeral component, and underwent revision to an allograft prosthetic composite.\"}]","Revision of Cemented Reverse Total Shoulder Arthroplasty with Bone Graft in Osteogenesis Imperfecta - A Case Report | PDF",1790720452,18]