The Classic: Delta Shoulder Prosthesis for Rotator Cuff Rupture

Grammont, P; Baulot, Emmanuel

doi:10.1007/s11999-011-1960-5

Cited by 114 publications

(120 citation statements)

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“…The modern RTSA was designed to restore balance to a shoulder with a massive, irreparable rotator cuff tear and CTA [24,25]. Balance is reestablished by component design that restores deltoid tension and locates the center of rotation within the glenoid.…”

Section: Discussionmentioning

confidence: 99%

“…Balance is reestablished by component design that restores deltoid tension and locates the center of rotation within the glenoid. The RTSA thus recreates the fulcrum required to allow active elevation by the deltoid [24].…”

Section: Discussionmentioning

confidence: 99%

“…The current iteration reverse total shoulder arthroplasty (RTSA) has been in use in Europe since the late 1980s [24,25], and was approved by the FDA for use in the United States in 2004 [7]. The RTSA was originally designed to treat a massive irreparable rotator cuff with superior migration of the humeral head combined with glenohumeral arthritis (cuff tear arthropathy [CTA]) [5,15,18,21,40].…”

Section: Introductionmentioning

confidence: 99%

“…By restoring deltoid tension and moving the center of rotation within the glenoid, as described by Grammont and Baulot (Fig. 2), not only is the fulcrum recreated, but loosening of the glenoid component, which plagued the early designs of RTSA, is substantially reduced [24].…”

Section: Introductionmentioning

confidence: 99%

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Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Drake¹,

O’Connor

Edwards

2010

Clinical Orthopaedics &Amp; Related Research

215

129

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Background Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear. Questions/purposes We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.Methods We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.Results Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short-and mediumterm followup studies. Conclusions In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA. Clinical Relevance For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction. Level of Evidence Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Drake¹,

O’Connor

Edwards

2010

Clinical Orthopaedics &Amp; Related Research

215

129

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“…The Aequalis 1 Reversed Shoulder Prosthesis (Tornier Inc, Houston, TX) is a reverse ball-and-socket prosthesis designed according to Grammont's principles [15,16]. To accommodate the bone graft and facilitate stable fixation in the native glenoid, a specific baseplate with a lengthened central peg (25 mm) was designed and implanted in all cases.…”

Section: Patients and Materialsmentioning

confidence: 99%

Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation

Boileau

Moineau

Roussanne

et al. 2011

Clinical Orthopaedics &Amp; Related Research

403

326

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Background Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure. Questions/purposes We asked whether bony lateralization of reverse shoulder arthroplasty would avoid the problems caused by humeral medialization without increasing torque or shear force applied to the glenoid component. Patients and Methods We prospectively followed 42 patients with rotator cuff deficiency treated with bony increased-offset reverse shoulder arthroplasty. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate. Graft and baseplate fixation was achieved using a lengthened central peg (25 mm) and four screws. Patients underwent clinical, radiographic, and CT assessment at a minimum of 2 years after surgery. ResultsThe humeral graft incorporated completely in 98% of cases (41 of 42) and partially in one. At a mean of 28 months postoperatively, no graft resorption, glenoid loosening, or postoperative instability was observed. Inferior scapular notching occurred in 19% (eight of 42). The absolute Constant-Murley score improved from 31 to 67. Thirty-six patients (86%) were able to internally rotate sufficiently to reach their back over the sacrum. Conclusions Grafting of the glenoid surface during reverse shoulder arthroplasty effectively creates a long-necked scapula, providing the benefits of lateralization. Bony increased-offset reverse shoulder arthroplasty is associated with low rates of inferior scapular notching, improved shoulder rotation, no prosthetic instability and improved shoulder contour. In contrast to metallic lateralization, bony lateralization has the advantage of maintaining the prosthetic center of rotation at the prosthesis-bone interface, thus minimizing torque on the glenoid component.

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Reverse total shoulder arthroplasty

Sánchez-Sotelo

2008

Clinical Anatomy

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Reverse total shoulder arthroplasty designs have gained popularity over the last few years due to their satisfactory functional results in patients with cuff-tear arthropathy and other difficult reconstructive shoulder problems. These semiconstrained prostheses improve stability and active elevation in the absence of a functional rotator cuff by coupling a spherical glenoid component with a concave humeral component and increasing deltoid tension. Understanding the anatomy of the shoulder is critical in order to ensure secure fixation of the glenoid component, explore uncemented options for humeral component fixation, and determine the ideal soft-tissue tension to provide the best functional outcome without increasing the risk of complications. Key anatomic elements to be considered for the successful implantation of a reverse prosthesis include the orientation and size of the glenoid vault, the scapular regions with better bone stock (coracoid, spine of the scapula), the internal geometry of the humeral medullary canal, and the effects of reverse arthroplasty on the deltoid and brachial plexus.

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The Classic: Delta Shoulder Prosthesis for Rotator Cuff Rupture

Cited by 114 publications

References 1 publication

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation

Reverse total shoulder arthroplasty

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