Expanding roles for reverse shoulder arthroplasty

Abstract

Since its introduction in the USA in 2003, reverse total shoulder arthroplasty (RTSA) has been used with increasingly frequency as surgeons have observed the remarkable improvement in pain, range of motion, and function associated with this implant. RTSA was initially used exclusively for elderly, low demand individuals with end-stage rotator cuff tear arthropathy. However, RTSA is now being increasingly successfully employed for the management of irreparable rotator cuff tears, glenohumeral osteoarthritis with an intact rotator cuff, acute proximal humerus fractures, the sequelae of proximal humerus fractures, neoplasms of the proximal humerus, inflammatory arthropathy, young patients and failed anatomic total shoulder arthroplasty and hemiarthroplasty. While long-term outcomes are pending, short-and mid-term follow-up results suggest that in experienced hands, RTSA may be a reasonable treatment for many previously difficult to treat pathologies within the shoulder.

Oncologic reconstruction of the proximal humerus with a reverse total shoulder arthroplasty megaprosthesis

“…In most cases, ensuring a complete resection will optimize patient survival as well as long‐term function . Until relatively recently, reconstruction of the resulting shoulder was limited to hemiarthroplasty or allograft prosthetic composites . Recent advances in the design of reverse total shoulder arthroplasty components has facilitated oncologic reconstructions .…”

“…Until relatively recently, reconstruction of the resulting shoulder was limited to hemiarthroplasty or allograft prosthetic composites . Recent advances in the design of reverse total shoulder arthroplasty components has facilitated oncologic reconstructions . We believe patient outcome, both in terms of pain relief and function, are improved through the use of reverse total shoulder arthroplasty in these patients, without an increase in complications.…”

“…Anterosuperior escape is common and can be quite debilitating, due to both poor function and persistent pain . Reverse shoulder arthroplasty may provide a more reliable outcome and better functional and pain outcomes . In this semi‐constrained implant, the deltoid muscle is used to provide function in the absence of a rotator cuff .…”

“…5 Reverse shoulder arthroplasty may provide a more reliable outcome and better functional and pain outcomes. 6 In this semi-constrained implant, the deltoid muscle is used to provide function in the absence of a rotator cuff. 7,8 Reverse total shoulder arthroplasty has been used at our institution for patients requiring oncologic resections of the proximal humerus with promising outcomes.…”

“…2,6 Recent advances in the design of reverse total shoulder arthroplasty components has facilitated oncologic reconstructions. 6 We believe patient outcome, both in terms of pain relief and function,…”