Reverse Total Shoulder Arthroplasty

Summary

Reverse total shoulder arthroplasty is indicated for the treatment of conditions that cannot be treated with conventional arthroplasty or other procedures. These primarily include degenerative and incapacitating conditions with irreparable rotator cuff and loss of the normal biomechanical coupling of the shoulder.

Abstract

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in patients who were not appropriate for tendon transfer reconstructions. Traditional surgical options for these patients were limited and functional results were sub-optimal and at times catastrophic. The use of reverse shoulder arthroplasty has been found to effectively restore these patients function and relieve symptoms associated with their disease. The procedure can be done through two approaches, the deltopectoral or the superolateral. Complication rates associated with the use of the prosthesis have ranged from 8-60% with more recent reports trending lower as experienced is gained. Salvage options for a failed reverse shoulder prosthesis are limited and often have significant associated disability. Indications for the use of this prosthesis continue to be evaluated including its use for revision arthroplasty, proximal humeral fracture and tumor. Careful patient selection is essential because of the significant risks associated with the procedure.

Protocol

1. Introduction:

The glenohumeral joint is a complex articulation. It has minimal bony constraints and relies on a complex balance of tensions between supporting soft tissues for normal function. This essential relationship allows the shoulder to have a large functional range of motion. When this balance is uncoupled, varying degrees of dysfunction occur. A loss of function of the rotator cuff, such as a large tear, can cause superior translation of the humeral head on the glenoid. This changes the center of rotation of the glenohumeral joint and subsequently, the tension and moment arms of the remaining musculature, decreasing function. Add....

Discussion

The use of RTSA for rotator cuff arthropathy provides significant improvements in pain, range of motion and functional outcomes scores. Overall patient satisfaction has ranged from 80-95% in the current literature. Like all procedures, RTSA is not without risk. Initial reports of complication were as high as 60%. As techniques have improved the complication rates have decreased.

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Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Aequalis Reversed Shoulder	Tornier, Inc.	none	For more information visit http://www.tornier-us.com/