Reverse total shoulder arthroplasty

Abstract

Since the introduction of reverse total shoulder arthroplasty (RTSA) in 1987 (in Europe) and 2004 (in the United States), the number of RTSAs performed annually has increased.Although the main indication for RTSA has been rotator cuff tears, indications have expanded to include several shoulder conditions, many of which involve dysfunction of the rotator cuff.RTSA complications have been reported to affect 19% to 68% of patients and include acromial fracture, haematoma, infection, instability, mechanical baseplate failure, neurological injury, periprosthetic fracture and scapular notching.Current controversies in RTSA include optimal baseplate positioning, humeral neck-shaft angle (135° versus 155°), glenosphere placement (medial, lateral or bony increased offset RTSA) and subscapularis repair.Improvements in prosthesis design, surgeon experience and clinical results will need to occur to optimize this treatment for many shoulder conditions. Cite this article: EFORT Open Rev 2018;3:58-69 DOI: 10.1302/2058-5241.3.170044.

Keywords: clinical outcomes; complications; contraindications; indications; reverse total shoulder arthroplasty.

Fig. 1

a) Anteroposterior (AP) radiograph of a shoulder with rotator cuff tear arthropathy showing superior joint space narrowing; b) post-operative radiograph of RTSA.

Fig. 2

a) Photograph of a man with superior subluxation of the right shoulder, typical of painless pseudoparalysis; b) radiographic appearance of the shoulder pre-operatively showing classical findings of cuff tear arthropathy; c) post-operative range of abduction after RTSA; d) AP radiograph of implanted RTSA.

Fig. 3

a) AP radiograph of a proximal humerus fracture; b) post-operative radiograph of the fracture treated with RTSA.

Fig. 4

a) AP radiograph of a malunited proximal humerus fracture; b) post-operative radiograph of the fracture treated with RTSA.

Fig. 5

glenoid erosion of primary glenohumeral arthritis. Reprinted with permission from Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty 1999;14:756-60.

Fig. 6

a) AP radiograph of a shoulder with osteoarthritis, an intact rotator cuff and major glenoid bone loss; b) axial view of a CT scan of the shoulder showing 35° of retroversion; c) AP radiograph of the shoulder treated with RTSA without bone grafting.

Fig. 7

a) AP radiograph of a locked dislocation; b) axial view of a CT scan of the same patient with glenoid bone loss; c) AP radiograph of the shoulder treated with RTSA.

Fig. 8

a) AP radiograph of a failed TSA; b) AP post-operative radiograph after RTSA.

Fig. 9

AP radiograph of a dislocated RTSA.

Fig. 10

Diagram showing the different head-neck angles of Grammont-type prostheses vs a more horizontal head-neck angle seen in more recent designs. Reprinted with permission from Oh JH, Shin SJ, McGarry MH, Scott JH, Heckmann N, Lee TQ. Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2014;23:1091-8.

Fig. 11

AP radiograph of notching of the inferior glenoid (arrow) after RTSA.

Fig. 12

AP radiograph of a baseplate failure after RTSA.