Uncommon Indications for Reverse Total Shoulder Arthroplasty

Abstract

Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty.

The influence of humeral head inclination in reverse total shoulder arthroplasty: a systematic review

“…7,9 Since the inception of the reversed prosthesis, there have been several design permutations, including changes in humeral head inclination, an increase in the size of the glenosphere, and the medialization of the center of rotation of the humeral head. 7 The medialization concept was introduced by Paul Grammont in the 1980s as a way to decrease shear forces at the glenosphere and increase the deltoid lever arm in patients with rotator cuff deficiency.…”

La artroplastia invertida de hombro ante defectos óseos glenoideos

“…La artroplastia mejora el dolor y la función en estos pacientes 3 . A la dificultad técnica inherente a la implantación de la prótesis deben añadirse los defectos óseos de la glena, ya que la falta de remanente óseo impide la adecuada fijación del implante, aumentando la posibilidad de fracaso de la intervención quirúrgica 4 .…”

The effects of implant design variations on shoulder instability following reverse shoulder arthroplasty

“…Patients in need of RSA typically suffer from the following: rotator cuff deficiencies with accompanying osteoarthritis, severe proximal humeral fractures, or previously failed arthroplasty (Fig. 10) [7,9,26,51,55,65]. In all cases, the biomechanical fulcrum for elevation is lost and unable to be restored with rotator cuff surgery or other arthroplasties.…”

“…Deficiency in the anterosuperior or postero-superior cuff, in particular, leads to subluxation and produces increased risk of pseudoparalysis if left untreated [14]. Hemi or total shoulder arthroplasty are unable to resolve anterior-superior escape or reproduce rotator cuff force couples, resulting in loss of motion and function [26]. Reverse shoulder arthroplasty restores mobility by moving the center of rotation medially on the glenoid, which allows elevated deltoid forces.…”

“…Reverse shoulder arthroplasty restores mobility by moving the center of rotation medially on the glenoid, which allows elevated deltoid forces. Additionally, lowering the humerus places the deltoid under tension, further stabilizing the joint [26]. Figure 10.…”