Reverse Shoulder Arthroplasty Indications, Technique, and Results

The surgical treatment of glenohumeral arthritis with rotator cuff deficiency is a difficult challenge. Hemiarthroplasty, the standard treatment at this time, is associated with satisfactory results in a ‘‘limited goals’’ perspective, but often the clinical results are unpredictable. Elevation after hemiarthroplasty approximately 90 . Pain relief can be inconsistent and can deteriorate over time. Constrained prostheses, including ball and socket and reverse ball and socket designs, were introduced in the 1970s to improve upon the results of arthroplasty in this challenging population. Unfortunately, clinical results were inconsistent using these designs, and rates of mechanical loosening and revision were high. The only design that survived has been the prosthesis of Paul Grammont (Dijon, France). His Delta III Prosthesis (DePuy, Warsaw IN) has been in use in its current form since 1992, with good clinical results and relatively low mechanical loosening rates compared with the ball and socket and reversed ball and socket designs of the past. This design is also utilized by the Tornier Aequalis Reversed Prosthesis (Tornier SA, Montbonnot, FR). In Europe, and more recently in the United States, this prosthetic design has proven useful in treating patients with glenohumeral arthritis with extensive cuff deficiency, proximal humeral fracture nonunions and malunions, and failed arthroplasty with a deficient rotator cuff. Predictably good results can be obtained in these difficult circumstances, with good pain relief and elevation often exceeding the horizontal. Active rotation, however, is usually not improved. Complication rates are low in patients with cuff tear arthritis and relatively high in revision arthroplasty cases. As with all revision operations, be they failed cuff repairs or failed prosthetic replacements, there is a higher risk of lingering low grade infections. Results can be optimized and complications minimized with proper patient selection, fastidious surgical technique, and proper postoperative rehabilitation.