REVERSE SHOULDER ARTHROPLASTY

Gonzalo Samitier MD, PhD

HFHS Sports Medicine Fellow

NO INTEREST CONFLICT

1917 - 2011

“… outcomes of shoulder arthroplasty were poorer when the rotator cuff was not functional"

Charles S. Neer

Rocking horse phenomenon

"Rocking horse phenomenon"

ROTATOR CUFF ARTHROPATHY

"If at first the idea is not absurd, then there is no hope for it."

"Get a good idea and stay with it. Dog it, and work at it until it’s done right."

- Walt Disney

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

Increasing Indications, complications and … Imitations

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"

DESIGNS

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

Result Reverse TSA 1 Year F/U

Result after irreparable RCT

SURGICAL TECHNIQUE

https://www.vumedi.com/video/reverse-total-shoulder-arthroplasty-technical-note-and-results-at-uf/

MADRID

MADRID

MADRID