The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency

Frankle, Mark A.; Levy, Jonathan C.; Pupello, Derek; Siegal, Steven; Saleem, Arif; Mighell, Mark A.; Vasey, Matthew

doi:10.2106/jbjs.f.00123

Cited by 170 publications

(178 citation statements)

References 3 publications

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“…Risk of complication was nearly three times higher in revision arthroplasty cases. The magnitude of improvements in functional scores and active elevation and the complication rate were similar to those reported in other series of RTSA for rotator cuff arthropathy [6,12,20,54,60]. These data demonstrate that with proper use in rotator cuff deficient shoulders, patients can obtain excellent clinical function following implantation of a RTSA.…”

Section: Results Of Rtsa In Rotator Cuff Diseasesupporting

confidence: 84%

“…The RTSA is not indicated for all types of rotator cuff disease; however, it does demonstrate good function when treating CTA and massive rotator cuff tear with chronic pseudoparalysis and no glenohumeral arthritis [6,12,15,20,57]. Severe deltoid impairment is a contraindication to RTSA [18,21].…”

Section: Discussionmentioning

confidence: 99%

“…The RTSA effectively relieves symptoms and restores function for patients with CTA and irreparable rotator cuff tears [6,12,15,20,57]. Although the RTSA has improved treatment options for various problems associated with the rotator cuff, its use is not without problems.…”

Section: Discussionmentioning

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

208

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: Results Of Rtsa In Rotator Cuff Diseasesupporting

confidence: 84%

Section: Discussionmentioning

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

208

129

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“…The variables in the current prostheses have been developed to address concerns that have arisen with reverse shoulder arthroplasty. The persistent problems and high complication rate with this procedure have been described extensively in the current literature, with complications including hematoma formation [48], infection [5,15,18,45,48,49], scapular notching [28,44,45,49], instability [18,48,49], acromial insufficiency [15,48], and glenoid component failures [14,17,42,45]. Additionally, complications and patient satisfaction vary among primary cuff tear arthroplasty, revision cases, and fractures [5,15,18,45,48,49].…”

Section: Discussionmentioning

confidence: 99%

“…Debate exists over the medialization of the center of rotation, with some proposing a more lateral offset [15]. Proponents of the more lateral center of rotation point to a lower rate of scapular notching and an increase in impingement-free motion [19].…”

Section: Discussionmentioning

confidence: 99%

A History of Reverse Total Shoulder Arthroplasty

Flatow

Harrison

2011

Clinical Orthopaedics &Amp; Related Research

173

108

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Background Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs. Questions/purposes This review explores the development of reverse shoulder arthroplasty, specifically describing (1) the evolution of reverse shoulder arthroplasty designs, (2) the biomechanical variations in the evolution of this arthroplasty, and (3) the current issues relevant to reverse shoulder arthroplasty today. Methods Using a PubMed search, the literature was explored for articles addressing reverse shoulder arthroplasty, focusing on those papers with historical context. Results Results of the early designs were apparently poor, although they were not subjected to rigorous clinical research and usually reported only in secondary literature. We identified a trend of glenoid component failure in the early reverse designs. This trend was recognized and reported by authors as the reverse shoulder evolved.Authors reported greater pain relief and better function in reverse shoulder arthroplasty with the fundamental change of Grammont's design (moving the center of rotation medially and distally). However, current reports suggest lingering concerns and challenges with today's designs. Conclusions The history of reverse shoulder arthroplasty involves the designs of many forward-thinking surgeons. Many of these highly constrained systems failed, although more recent designs have demonstrated improved longevity and implant performance. Reverse shoulder arthroplasty requires ongoing study, with challenges and controversies remaining around present-day designs.

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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 Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency

Cited by 170 publications

References 3 publications

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

A History of Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty

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