Advances and Update on Reverse Total Shoulder Arthroplasty

Abstract

Purpose of Review Reverse total shoulder arthroplasty (RTSA) is a procedure that has been increasingly utilized since its inception over 20 years ago. The purpose of this review is to present the most up to date practice and advances to the RTSA literature from the last 5 years. Recent Findings Recent literature on RTSA has focused on identifying complications, maximizing outcomes, and determining its cost-effectiveness. RTSA has become a valuable tool in the treatment of various shoulder pathologies from fractures to massiveirreparable rotator cuff tears. Maximizing outcomes, proper patient counseling, and limiting complications are vital to a successful procedure. Summary RTSA can be a difficult procedure; however, when utilized appropriately, it can be an invaluable tool in the orthopedic surgeon's armament. Recent evidence suggests, more and more, that RTSA not only provides value to the patient, but it is also cost-effective.Keywords Reverse total shoulder arthroplasty . RTSA . Reverse shoulder . Reverse shoulder arthroplasty . Reverse shoulder prosthesis . Outcomes models: (1) By eliminating the neck, the joint's center of rotation (COR) is in direct contact with the center of the glenosphere, providing a fixed COR and reducing the amount of torque placed on the glenoid component-bone interface; (2) the large-diameter glenosphere improves mobility and stability;(3) medializing the COR recruits more deltoid fibers for elevation and abduction; and (4) distalization of the COR improves the deltoid's moment arm by restoring its length, thereby decreasing the effort necessary for abduction [3][4][5][6][7][8][9]. These modifications allow the deltoid to initiate shoulder abduction in the absence of a functioning supraspinatus [8][9][10].

Cost-utility analysis of total shoulder arthroplasty: a prospective health economic study using real-world data

“…25 The majority of our working patients returned to work, on average 76 days after surgery; this observation is consistent with the mean time to return to work ranging from 1.4 to 4.0 months reported in a recent systematic review. 34 In contrast, our return-to-work rate was higher than the 63%-65% rates of returning to work described by Thon et al 34 The reasons for this difference may be attributed to a number of factors including our patients who may have been employed in positions requiring less labor-intensive work, differences in working conditions abroad (ie, most of the studies included in the review were conducted in the United States), and longer follow-up time points (eg, some patients were retired by the 5-year postoperative assessment).…”

“…3 Total shoulder arthroplasty (TSA) is known to provide good outcomes in terms of safe and efficient pain relief, as well as improved shoulder function and QOL. 1,3,34 Owing to the growing aging population and its expectations to stay active, as well as the development of improved implant designs and the technique of reverse TSA with its broader indications, the number of shoulder arthroplasties has increased nearly 10-fold in the past 3 decades. 33,34,36 With this trend, the emerging socioeconomic burden will drive future discussions to consider the proper allocation of limited financial resources.…”

“…1,3,34 Owing to the growing aging population and its expectations to stay active, as well as the development of improved implant designs and the technique of reverse TSA with its broader indications, the number of shoulder arthroplasties has increased nearly 10-fold in the past 3 decades. 33,34,36 With this trend, the emerging socioeconomic burden will drive future discussions to consider the proper allocation of limited financial resources. Health economic evaluations are therefore important for orthopedic surgeons, social insurance programs, and health policy decision makers and, in fact, play a role in outcome measure evaluations of surgical interventions.…”

A New Method to Determine the Humerus Height and Humeral Head Retroversion for Hemiarthroplasty

“…However, most surgeons tend to choose hemiarthroplasty in the patients ≤65 years, and tend to choose reverse total shoulder arthroplasty in old patients with lower-demand or teared rotator cuff (19)(20)(21)(22)(23).Arthroplasty for proximal humeral fracture is performed with the aim of restoring normal biomechanics, achieving adequate range of movement and providing a painless functional joint to the patients. The best advantage of arthroplasty is a reliable procedure for pain relief.…”

Anatomic placement of shoulder prosthesis for complex proximal humerus fractures: A modified method for hemiarthroplasty

“…The integrity of the medial hinge, and the length of the dorsomedial metaphyseal extension have been described as key prognostic factors for humeral head vascularity which may lead to the necrosis of humeral head (13,14).The most important indication of arthroplasty is fracture type, including head-splitting patterns, fracture dislocations, and displaced three-and four-part fractures not amenable to surgical fixation (12,15). However, most surgeons tend to choose hemiarthroplasty in the patients ≤65 years, and tend to choose reverse total shoulder arthroplasty in old patients with lower-demand or teared rotator cuff (16)(17)(18)(19)(20).Arthroplasty for proximal humeral fracture is performed with the aim of restoring normal biomechanics, achieving adequate range of movement and providing a painless functional joint to the patients. The best advantage of arthroplasty is a reliable procedure for pain relief.…”