Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff

Abstract

We reviewed 80 shoulders (77 patients) at a mean follow-up of 44 months after insertion of a Grammont inverted shoulder prosthesis. Three implants had failed and had been revised. The mean Constant score had increased from 22.6 points pre-operatively to 65.6 points at review. In 96% of these shoulders there was no or only minimal pain. The mean active forward elevation increased from 73 degrees to 138 degrees. The integrity of teres minor is essential for the recovery of external rotation and significantly influenced the Constant score. Five cases of aseptic loosening of the glenoid and seven of dissociation of the glenoid component were noted. This study confirms the promising early results obtained with the inverted prosthesis in the treatment of a cuff-tear arthropathy. It should be considered in the treatment of osteoarthritis with a massive tear of the cuff but should be reserved for elderly patients.

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

“…Although the RTSA has improved treatment options for various problems associated with the rotator cuff, its use is not without problems. Complication rates have been reported from 10% to 47% [12,14,20,26,32,54,57,60] and the dislocation rate is reportedly 0% to 9% [12,26,32,50,54,57]. The dislocation rate is nearly doubled in patients without a subscapularis tendon [17].…”

“…The indications for RTSA have expanded over the last few years and include CTA [15,18,26,50,57,61], inflammatory arthropathy with massive rotator cuff tear [26,45], proximal humeral nonunion or malunion [6,34,57], acute fractures [34,57,58], fixed glenohumeral dislocation [57], posttraumatic arthritis [26,57], tumor [4,13,35,57], revision arthroplasty [6,27,33,57], and chronic pseudoparalysis without arthritis [41,57,60,61]. We will limit our discussion to problems dealing with the rotator cuff.…”

A History of Reverse Total Shoulder Arthroplasty

“…These indications and contraindications continue to be debated, such as how one defines pseudoparalysis and at what age a patient is ''too young'' for a reverse shoulder arthroplasty. The improved outcomes possible with this prosthesis have been well documented [18,45,47,48]. The improvements in pain and ROM have therefore made reverse arthroplasty an increasingly commonly selected option for patients and subject for study.…”

“…The variables in the current prostheses have been developed to address concerns that have arisen with reverse shoulder arthroplasty. The persistent problems and high complication rate with this procedure have been described extensively in the current literature, with complications including hematoma formation [48], infection [5,15,18,45,48,49], scapular notching [28,44,45,49], instability [18,48,49], acromial insufficiency [15,48], and glenoid component failures [14,17,42,45]. Additionally, complications and patient satisfaction vary among primary cuff tear arthroplasty, revision cases, and fractures [5,15,18,45,48,49].…”

In vitro assessments of reverse glenoid stability using displacement gages are misleading — Recommendations for accurate measurements of interface micromotion

“…Reverse total shoulder arthroplasty has been shown to improve function and pain in the treatment of massive rotator cuff tear and cuff tear arthropathy, rheumatoid arthritis, fractures, or revision arthroplasty (Boileau et al, 2006, Gerber et al, 2009, Guery et al, 2006, Sirveaux et al, 2004, Werner et al, 2005. Nevertheless, the rate of problems remains high, in part because of glenoid component loosening (Gerber et al, 2009, Mole andFavard, 2007).…”