Grammont’s Idea: The Story of Paul Grammont’s Functional Surgery Concept and the Development of the Reverse Principle

Abstract

Background The increased use of the reverse prosthesis over the last 10 years is due to a large series of publications using the reverse prosthesis developed by Paul Grammont. However, there is no article reporting the story of the concepts developed by Grammont. Questions/purposes The purposes of this review are to describe the principles developed by Grammont, the chronology of development, and the biomechanical concepts and studies that led to the current design of the reverse prosthesis. Methods We selectively reviewed literature and provide personal observations. Results From phylogenetic observations, Grammont developed the principle of functional surgery applied to the rotator cuff tears. To increase the deltoid lever arm, he imagined two possibilities: the lateralization of the acromion, which facilitates the action of the rotator cuff, and the medialization of the center of rotation, which has been developed to respond to situations of rotator cuff deficiency. Grammont proposed the use of an acromiohumeral prosthesis, which was quickly abandoned due to problems of acromial loosening. Finally, Grammont used the principle of reverse prosthesis developed in the 1970s, but made a major change by medializing the center of rotation in a nonanatomic location. In 1985, Grammont validated the concept by an experimental study and the first model using a cemented sphere was implanted. Conclusions The development of the modern reverse prosthesis is the result of the intellectual and experimental work conducted by Grammont and his team for 20 years. Knowledge of this history is essential to envision future developments.

Outcomes of staged bilateral reverse shoulder arthroplasties for rotator cuff tear arthropathy

“…Radiographs were reviewed preoperatively by the senior surgeon (T.B.E.) to determine the classification of rotator cuff tear arthropathy according to Hamada et al (grades [1][2][3][4][5] and glenoid erosion according to Sirveaux et al (types E0, E1, E2, E3). 19,35 The status of the subscapularis and teres minor was evaluated by the senior surgeon (T.B.E.)…”

Early Follow-up of Reverse Total Shoulder Arthroplasty in Patients Sixty Years of Age or Younger

“…A Grammont design reverse total shoulder prosthesis was implanted for all cases (Tornier, Saint-Ismier, France) 18,19 . No concomitant procedures were performed.…”

The influence of humeral head inclination in reverse total shoulder arthroplasty: a systematic review

“…7 The medialization concept was introduced by Paul Grammont in the 1980s as a way to decrease shear forces at the glenosphere and increase the deltoid lever arm in patients with rotator cuff deficiency. 1,7 By moving the center of rotation medially and inferiorly, the Grammont style prostheses increased the number of deltoid fibers available for abduction and forward elevation, increased the deltoid's efficiency by elongating the deltoid muscle, but weakened the teres minor and posterior deltoid for external rotation. 13 Medialization of the center of rotation was accompanied by the radiographic finding of scapular notching.…”