Expanding roles for reverse shoulder arthroplasty

Abstract

Since its introduction in the USA in 2003, reverse total shoulder arthroplasty (RTSA) has been used with increasingly frequency as surgeons have observed the remarkable improvement in pain, range of motion, and function associated with this implant. RTSA was initially used exclusively for elderly, low demand individuals with end-stage rotator cuff tear arthropathy. However, RTSA is now being increasingly successfully employed for the management of irreparable rotator cuff tears, glenohumeral osteoarthritis with an intact rotator cuff, acute proximal humerus fractures, the sequelae of proximal humerus fractures, neoplasms of the proximal humerus, inflammatory arthropathy, young patients and failed anatomic total shoulder arthroplasty and hemiarthroplasty. While long-term outcomes are pending, short- and mid-term follow-up results suggest that in experienced hands, RTSA may be a reasonable treatment for many previously difficult to treat pathologies within the shoulder.

Keywords: Glenohumeral osteoarthritis; Proximal humerus fracture; Reverse total shoulder arthroplasty; Revision shoulder arthroplasty; Rotator cuff tear; Rotator cuff tear arthropathy.

Fig. 1

This 62-year-old female sustained a 4-part proximal humerus fracture (Grashey anteroposterior and axillary radiographs shown in a and b), underwent open reduction and internal fixation with fibular strut allografting (c, d). Two-and-a-half years later, the patient presented with increasing pain. On examination the patient was found to have 80° active forward elevation and weakness in all planes of the rotator cuff. Radiographs (e, f) demonstrated avascular necrosis and glenoid osteophyte formation and an ultrasound demonstrated a full thickness anterosuperior rotator cuff tear. The patient underwent removal of hardware and reverse total shoulder arthroplasty (g, h) with restoration of range of motion