Ream less, move more: glenoid bone preservation in reverse total shoulder arthroplasty with augmented baseplate

Reverse total shoulder arthroplasty (RTSA) is an effective solution for various shoulder pathologies, but traditional correction of glenoid inclination through eccentric reaming can compromise bone stock and implant stability. Augmented baseplates offer a bone-preserving alternative, yet their role in patients without significant glenoid bone loss remains underexplored. This study evaluates augmented baseplates in patients with A1 glenoid without bone loss, where evidence is currently lacking. The primary rationale is to achieve controlled inferior tilt and lateralisation without excessive reaming or medialisation. A retrospective review was conducted on 24 patients with Walch type A1 glenoid who underwent primary RTSA between December 2018 and December 2021. Preoperative CT-based planning guided the use of half-wedge augmented baseplates. Primary outcomes included range of motion (ROM), strength, pain (VAS), function (VAS), QuickDASH, SANE, and ASES scores. Radiographic assessments evaluated component fixation and scapular notching. Data were analysed using paired t-tests with a significance set at p < 0.05. At a mean follow-up of 25.2 ± 10.0 months, all patients demonstrated significant improvements in forward flexion (90° to 150°; p < 0.001) and abduction (80° to 145°; p < 0.001). Pain scores decreased significantly (6.3 to 2.1; p < 0.001), and both ASES (38.6 to 71.2; p < 0.001) and QuickDASH scores (58.8 to 34.7; p < 0.001) improved markedly. No complications, scapular notching, or implant loosening were observed. The use of augmented baseplates in primary RTSA, even in patients without glenoid bone loss, is a reliable, bone-preserving technique that results in excellent mid-term clinical and radiographic outcomes.