Reverse shoulder arthroplasty

Abstract

The reverse shoulder arthroplasty emerged as a potential solution for those patients who could not be managed effectively with a conventional total shoulder arthroplasty. Grammont revolutionized the design by medializing and distalizing the center of rotation and utilizing a large convex glenoid surface and concave humeral component with a neck-shaft angle of 155°. This design has been highly successful in cuff deficient shoulders, and indications continue to broaden. Many mid-term studies have improved upon the early encouraging results. Long-term studies are starting to emerge, demonstrating good survivorship, but progressive functional and radiographic deterioration continue to be concerning. Careful patient selection and attention to appropriate technique are required to reduce the current high rate of complications. New prosthesis designs are continuing to develop to address some of these limitations.

Analysis of the Internet Information Regarding Reverse total Shoulder Arthroplasty

“…Conventional total shoulder replacements (TSA) are implanted with the goal of replicating and restoring the functional anatomy of an arthritic glenohumeral joint [1]. In the majority of patients this procedure provides excellent pain relief and restoration of function [1,2].…”

“…In the majority of patients this procedure provides excellent pain relief and restoration of function [1,2]. Patients with a combination of glenohumeral arthritis and a massive rotator cuff tear, however, have been historically more difficult to treat and experience relatively unsatisfactory results with a TSA [1][2][3].…”

Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review

“…Cuff tears in rheumatoid patients are extremely common (20%-100%) [6,9,10] and when present, lead to inferior results of joint replacement due to poor pain relief, superior humeral migration, increased shear forces, eccentric wear, instability, early failure and glenoid loosening rates as high as 50% [6,7,[11][12][13][14]. It is therefore clear that the rotator cuff is an important prognosticator of outcome.…”

“…The biomechanical features of this design confer increased stability (particularly against superior escape) and a significantly improved lever arm for deltoid, potentially resulting in improved range and strength of abduction even in the presence of a deficient rotator cuff [14,25,26]. Despite these biomechanical improvements, expert authors have previously cautioned against using RSA in RA patients due to concerns about increased peri-operative complications, poor functional outcomes and high revision rates [27,28].…”

Reverse shoulder arthroplasty: The Singapore General Hospital experience and a simple method of measuring change in the center-of-rotation

“…2,5,9 However, there are currently no standardized methods of determining the change in COR pre-and post-operatively and furthermore, most studies on RSA do not include radiological assessments.…”