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1917 - 2011
“… outcomes of shoulder arthroplasty were poorer when the rotator cuff was not functional"
Charles S. Neer
Grammont Type Reverse
(France 1987)
Grammont P, Trouilloud P, Laffay JP, et al. Etude et realisation d’unenouvelleprothe`sed’e`paule.Rheumatologie. 1987;39:407–418. [French]
EARLY RESULTS
Sirveaux JBJS Br 2004 – Delta III
• 80 shoulders• 44 mo f/u average• 92.5% satisfied• Elevation improved 73 to 138• 64% scapular notching
Frankle et al JBJS Aug 2005 – Encore RSP
• 60 shoulders• 33 mo f/u• 95% satis• Elevation improved 55 to 105• No scapular notching
INDICATIONS RSA
• Cuff Tear Arthropathy (CTA)• Irreparable Massive cuff tear in elderly• Osteoarthritis with cuff tear in elderly• Proximal humerus malunion/nonunion of Tuberosities• Acute proximal humerus fractures in elderly??• Revision TSA – loose glenoid or failed cuff• Old infection (infection cleared)• Inflammatory arthritis with severe cuff deficiency• Tumor resection• Others
“… symptomatic shoulder with rotator cuff non functional"
PROBLEMS & COMPLICATIONS RSA
• Scapular notching 35.4%
• Instability 4.7%
• Infection 3.8%
• Glenoid loosening 3.5%
• Hematoma
• Acromial insufficiency fracture 1.5%
• Humeral loosening 1.3%
• Humerus fx 1.4%
• Neuropraxia 1.2%• Glenoid disassembly Humeral disassembly• Polyethylene dislocation
Matthias A. Zumstein, MDa,b, Miguel Pinedo, MDa,d, Jason Old, MD, FRCSCa,c, Pascal Boileau, MDa,* Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg (2011) 20, 146-157
• Problems 44%
• Complications 24%
• Reoperations 3.5%
• Revisions after 10%.
Matthias A. Zumstein, MDa,b, Miguel Pinedo, MDa,d, Jason Old, MD, FRCSCa,c, Pascal Boileau, MDa,* Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg (2011) 20, 146-157
PROBLEMS & COMPLICATIONS RSA
Lieven F de Wilde, Didier Poncet, Bart Middernacht, and Anders EkelundProsthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthopaedica 2010; 81 (6): 719–726
RESULTS
Smith CD, Guyver P, Bunker TD. Indications for reverse shoulder replacement: a systematic review. J Bone Joint Surg Br. 2012 May;94(5):577-83
SURGICAL TECHNIQUE
https://www.vumedi.com/video/reverse-total-shoulder-arthroplasty-technical-note-and-results-at-uf/