Reverse total shoulder arthroplasty: a review

Reverse shoulder arthroplasty (RSA) has developed from the work of Paul Grammont due to his dissatisfaction with the available surgical treatment options for severe rotator cuff disease and shoulder arthritis. Introducing the concept of a prosthetic design with a large spherical glenoid component, a medial center of rotation coincident with the glenoid surface, and medial and distal displacement of the humerus, he was able to demonstrate results superior to previous work. Interest in his work rapidly grew, and reverse arthroplasty is now used for many indications including cuff tear arthropathy, massive rotator cuff tearing, rheumatoid arthritis, acute and chronic proximal humeral fractures, and revision surgery. Results from RSA are good to excellent in most patients. Depending on the diagnostic indication, reported outcomes include mean pain scores of 1-2, active elevation of 130 to 140 degrees, and Constant scores of 60 to 70 or higher. Generally, better outcomes are found with massive rotator cuff tearing and cuff tear arthropathy, and lesser results with prosthetic revision surgery. Unfortunately, complications occur with some regularity. Scapular notching is quite frequent in many series, up to a near uniform incidence. Additional complications include postoperative hematoma and infection, acromial and scapular spine fractures, dislocation, loosening, and mechanical failure. Durability of these implants is also uncertain, with some authors reporting diminishing pain relief and function over time. Improvements in surgical technique and evolution in prosthetic design hopefully will improve the incidence of complications and premature failure. RSA is an exciting addition to the armamentarium of orthopedic surgeons. It has indicated for a number of complex disorders, but should be performed with discretion until the durability of these implants is more firmly established.