Indications for reverse shoulder replacement: A systematic review

Princess Elizabeth Orthopaedic Centre, Royal Devon And Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK.
The Bone & Joint Journal (Impact Factor: 3.31). 05/2012; 94(5):577-83. DOI: 10.1302/0301-620X.94B5.27596
Source: PubMed


The outcome of an anatomical shoulder replacement depends on an intact rotator cuff. In 1981 Grammont designed a novel large-head reverse shoulder replacement for patients with cuff deficiency. Such has been the success of this replacement that it has led to a rapid expansion of the indications. We performed a systematic review of the literature to evaluate the functional outcome of each indication for the reverse shoulder replacement. Secondary outcome measures of range of movement, pain scores and complication rates are also presented.

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    • "Although some studies have shown good results with rTSA for acute proximal humeral fractures, several studies have cautioned that the results may not be optimum as expected by the patient and surgeon. Smith et al.12) have pointed out that the outcomes after rTSA for proximal humeral fracture appear to be worse than those achieved in the treatment of cuff tear arthropathy. This conclusion was based on their findings that rTSA patients may still have limited postoperative abduction in the range of around 90° to 100° and that patients showed a wide variation in recovery of external rotation and internal rotation.12) "
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    ABSTRACT: Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty.
    Clinics in orthopedic surgery 12/2013; 5(4):243-255. DOI:10.4055/cios.2013.5.4.243
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    ABSTRACT: We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.
    European Journal of Orthopaedic Surgery & Traumatology 03/2013; 24(4). DOI:10.1007/s00590-013-1213-2 · 0.18 Impact Factor
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    ABSTRACT: Proximal humerus fractures are common and most often occur in the elderly, who may also suffer from osteopenia and multiple medical comorbidities. Codman first described these fractures as consisting of four parts: Articular head, greater tuberosity, lesser tuberosity and diaphysis. There are multiple modalities to treat these fractures, with the literature reporting that up to 80% can be effectively managed non-operatively. When surgery is indicated, one of the options is arthroplasty. Knowledge of normal shoulder anatomy is important as accurate reduction and fixation of the tuberosities is vital to a good outcome following arthroplasty for trauma. Hemiarthroplasty for fracture of the proximal humerus was first described by Neer, and has been used for over forty years. The results have demonstrated reliable pain relief but variable self-reported scores and functional outcomes, with dependence on anatomic tuberosity healing for satisfactory results. Reverse total shoulder arthroplasty has recently been introduced for treatment of proximal humerus fractures, demonstrating reliable pain relief and restoration of forward elevation. This review will summarize the available evidence and techniques for arthroplasty for the management of proximal humerus fractures.
    Minerva Ortopedica e Traumatologica 08/2013; 64(4):377-94.
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