A patient with a severe glenoid destruction and loss of rotator cuff function after arthroscopic rotator cuff surgery is presented. Within 6 months of the index surgery, she developed pain and stiffness of her right shoulder. Radiographs, magnetic resonance imaging (MRI) and especially the computed tomography (CT) scan showed a wide and deep bony glenoid defect, degeneration of the joint, partial head necrosis, and partial loss of the rotator cuff. During surgery, severe bone loss and destruction of the glenoid could be confirmed. By using autologous bone grafting in combination with a special baseplate construction (bony-increased offset-reverse shoulder arthroplasty, Bio-RSA), it was possible to restore the bony glenoid defect as well as to recenter the joint level and clinically achieve a pain-free functioning shoulder for the patient.