A history of reverse total shoulder arthroplasty

Abstract

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.

Fig. 1

Neer’s Mark I design with larger spherical component allowed greater motion. Reprinted with permission from Neer CS 2nd. Shoulder Reconstruction. Philadelphia, PA: WB Saunders; 1990. Copyright © 1990 Elsevier.

Fig. 2

Neer’s Mark III system incorporated axial rotation of the prosthetic stem. Reprinted with permission from Neer CS 2nd. Shoulder Reconstruction. Philadelphia, PA: WB Saunders; 1990. Copyright © 1990 Elsevier.

Fig. 3

The Bickel shoulder prosthesis illustrates the medialized glenoid component, which required substantial bone removal for implantation. Reprinted with permission from Cofield RH. Status of total shoulder arthroplasty. Arch Surg. 1977;112:1088–1091. Copyright © 1977 American Medical Association. All rights reserved.

Fig. 4

The Stanmore total shoulder prosthesis maintained the standard ball-and-socket glenohumeral articulation, although with increased constraint. The components snapped together after implantation and the glenoid was heavily supported by methylmethacrylate cement. Reprinted with permission from Cofield RH. Status of total shoulder arthroplasty. Arch Surg. 1977;112:1088–1091. Copyright © 1977 American Medical Association. All rights reserved.

Fig. 5

The Reverse Total Shoulder System designed by Reeves et al. included a divergent threaded peg glenoid component, demonstrated higher pullout strength than other designs in in vitro testing, and was designed around an instant center of rotation, which recreated the normal anatomic center. Reprinted with permission of Professional Engineering Publishing from Reeves B, Jobbins B, Dowson D, Wright V. A total shoulder endoprosthesis. Eng Med. 1974;1:64–67.

Fig. 6

Components of the shoulder prosthesis designed by Kölbel and Friedebold are shown. Reprinted with permission of Georg Thieme Verlag KG from Kölbel R, Friedebold G. Shoulder joint prosthesis [in German]. Z Orthop IhreGrenzgeb. 1975;113:452–454.

Fig. 7

The prosthesis designed by John M. Fenlin, Jr., illustrates the large glenosphere intended to maximize the deltoid function. Reprinted with permission from Fenlin JM Jr. Total glenohumeral joint replacement. Orthop Clin North Am. 1975;6:565–583. Copyright © 1975 Elsevier.

Fig. 8

In the Liverpool shoulder designed by Beddow and Elloy, the glenoid component and stem were fixed into the scapular pillar with the polyethylene socket cemented into the proximal humerus. This design recreated the anatomic center of rotation. Reprinted with kind permission of Springer Science + Business Media from Beddow FH, Elloy MA. Clinical experience with the Liverpool shoulder replacement. In: Bayley J, Kessel L, eds. Shoulder Surgery. Berlin, Germany: Springer-Verlag; 1982.