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.

Keywords: Arthritis; Arthroplasty; Fractures; Shoulder; Surgery.

Fig. 1

A 78-year-old male patient with massive rotator cuff tear without arthritis. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows proximal migration of the humeral head without glenohumeral arthritic change. (B) Conventional anteroposterior radiograph of the shoulder at 12 months' follow-up shows satisfactory positioning of the prosthesis with no signs of loosening. (C) Preoperative clinical picture shows active arm elevation at less than 90°. (D) Postoperative clinical picture shows active arm elevation was improved at 12 months' follow-up.

Fig. 2

A 74-year-old female patient with proximal humeral fracture. (A) Preoperative shoulder conventional anteroposterior radiograph of the shoulder shows severe comminuted proximal humeral fracture. (B) Conventional anteroposterior radiograph at 14 months' follow-up shows a well-fixed prosthesis.

Fig. 3

A 78-year-old female patient with proximal malunited fracture. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows distorted greater tuberosity (arrow head) and inferior part of humeral head (arrow). (B) Preoperative axillary radiograph of the shoulder also shows distorted alignment between the head and shaft. (C) Conventional anteroposterior radiograph of the shoulder at 2 years' follow-up shows a well-fixed prosthesis.

Fig. 4

A 53-year-old male patient with osteoarthritis with glenoid bone loss. (A) Preoperative conventional anteroposterior radiograph of the shoulder and (B) preoperative conventional axillary radiograph of the shoulder show severe bony erosion of posterior glenoid (arrow). Postoperative conventional shoulder radiographs at 25 months' follow-up show a well-fixed prosthesis: (C) anteroposterior view, and (D) axillary view.

Fig. 5

A 44-year-old female patient with glenoid dysplasia. (A) Preoperative conventional anteroposterior radiograph of the shoulder showing the altered glenoid anatomy, consistent with dysplasia. (B) Preoperative computed tomography scan, axial cut shows narrowed joint space and severely distorted articular surfaces of head and glenoid (dotted circle). Conventional radiographs of the shoulder at 6 months' follow-up show a well-fixed prosthesis: (C) anteroposterior view, and (D) axillary view.

Fig. 6

A 42-year-old female patient with chronic locked anterior dislocation. The anteroposterior (A) and axillary (B) preoperative conventional radiographs of the shoulder show a severe engaged Hill-Sachs lesion (multiple arrows) and unreduced chronic anterior dislocation. (C) Conventional anteroposterior radiograph of the shoulder at 8 months' follow-up shows a well-fixed prosthesis.

Fig. 7

A 47-year-old female patient with rheumatoid arthritis. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows severely eroded articular surfaces of glenoid and humeral head. (B) Conventional anteroposterior radiograph of the shoulder at 4 months' follow-up shows a well-fixed prosthesis.

Fig. 8

A 47-year-old female patient with history of failed rotator cuff repair. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows proximal migration of the humeral head. (B) Preoperative conventional axillary radiograph of the shoulder shows the humeral head has migrated anteriorly. (C) Deltoid atrophy (arrow) was evident in the preoperative physical examination. Conventional radiographs at 1 month follow-up show a well-fixed prosthesis: (D) anteroposterior view, and (E) axillary view.