Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World

Erickson, Brandon J.; Bohl, Daniel D.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.; Harris, Joshua D.

doi:10.12788/ajo.2018.0079

Cited by 29 publications

(22 citation statements)

References 23 publications

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“…A variety of patient-specific factors, including both modifiable and non-modifiable factors, impact outcomes following RTSA, including age, sex, and body mass index (BMI). The majority of patients who undergo RTSA are females above the age of 60 [19]. In the current literature, comparisons of RTSA outcomes across age groups are not equivocal.…”

Section: Preoperative Patient-specific Factorsmentioning

confidence: 97%

“…Rotator cuff tear arthropathy (CTA), characterized by rotator cuff dysfunction in the setting of end-stage arthritis, is the most common indication for RTSA [19,29]. Depending on the degree of arthritic change and pattern of the rotator cuff tear, patients typically complain of shoulder pain, weakness, and progressive loss of function [30,31].…”

Section: Rtsa For Massive Irreparable Rotator Cuff Tearsmentioning

confidence: 99%

“…Alternatively, patients may present with pseudoparalysis which is the loss of active arm elevation in the absence of glenohumeral arthritis due to a massive irreparable rotator cuff tear (MIRCT). Pseudoparalysis is the second most common indication for RTSA [19].…”

Section: Rtsa For Massive Irreparable Rotator Cuff Tearsmentioning

confidence: 99%

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Advances and Update on Reverse Total Shoulder Arthroplasty

Thon

Seidl

Bravman

et al. 2019

Curr Rev Musculoskelet Med

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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].

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Section: Preoperative Patient-specific Factorsmentioning

confidence: 97%

Section: Rtsa For Massive Irreparable Rotator Cuff Tearsmentioning

confidence: 99%

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Advances and Update on Reverse Total Shoulder Arthroplasty

Thon

Seidl

Bravman

et al. 2019

Curr Rev Musculoskelet Med

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“…Subscapularis repair in RTSA remains a controversial subject. 2,4,10,12 Many subscapularis repair techniques are used in practice, and debate exists as to the optimal technique. 3,16 The ideal technique would provide improvements in stability, strength, and ROM without altering the biomechanics of the joint.…”

Section: Discussionmentioning

confidence: 99%

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Erickson

Shishani

Bishop

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Treatment of the subscapularis in reverse total shoulder arthroplasty (RTSA) is a controversial topic, with conflicting evidence regarding outcomes after repair. Purpose/Hypothesis: The purpose of this study was to report clinical and sonographic outcomes of a through-implant double-row suture technique for subscapularis repair in RTSA and to compare clinical outcomes and range of motion (ROM) between patients with an intact subscapularis tendon repair versus those whose tendon repair was not intact. The authors hypothesized that the novel repair technique would find more than 80% of tendons intact on ultrasound, with significant improvement in clinical outcome scores and ROM. The authors also hypothesized that patients with an intact subscapularis tendon repair would have better clinical outcomes compared with those with a nonintact tendon repair. Study Design: Case series; Level of evidence, 4. Methods: The study included all patients who underwent RTSA by 1 of 2 surgeons between August 2016 and March 2017 with the through-implant double-row suture technique for subscapularis repair. Subscapularis tendon integrity was assessed postoperatively via ultrasound at minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain visual analog scale (VAS) scores were recorded at the final follow-up visit in addition to ROM measures. Results: A total of 48 patients (31 males, 17 females; mean age, 68.9 ± 7.4 years; mean follow-up, 13.8 ± 2.1 months) were included. On ultrasound, the subscapularis was intact in 83.3% of patients. Regarding preoperative versus postoperative outcome scores, the ASES score (mean ± SD) significantly improved from 38.3 ± 14.7 to 81.9 ± 13.6, the SANE score significantly improved from 29.8 ± 24.2 to 75.5 ± 21.0, and the VAS pain score significantly improved from 5.9 ± 2.1 to 1.2 ± 1.6 ( P < .001 for all). Forward flexion and external rotation significantly improved. No significant difference existed in clinical outcome scores or ROM between patients with intact versus torn subscapularis tendons based on ultrasound. Conclusion: Subscapularis repair using a stem-based double-row repair technique during RTSA demonstrated an overall healing rate of 83.3%, as evidenced by ultrasound examination at short-term follow-up. Integrity of subscapularis repair did not affect clinical outcome or ROM.

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“…These improved results could be for various reasons, with progress in prosthesis design being particularly relevant. The presence of reverse prostheses should be noted as they have become one of the treatments of choice for pathologies like proximal humeral fractures or rotator cuff arthropathy [56][57][58][59]. The results obtained when assessing reverse prostheses suggest that, while their rate of complications might be slightly higher than those observed in other contexts [9,15,[52][53][54], their results could be better when compared to other types of prostheses [32,33,36,48].…”

Section: Discussionmentioning

confidence: 99%

Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review

Torre

García

Smith

et al. 2019

JCM

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The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant–Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.

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Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World

Cited by 29 publications

References 23 publications

Advances and Update on Reverse Total Shoulder Arthroplasty

Advances and Update on Reverse Total Shoulder Arthroplasty

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Safety and Effectiveness of Shoulder Arthroplasties in Spain: A Systematic Review

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