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Expanding roles for reverse shoulder arthroplasty

  • Shoulder Arthroplasty (G Athwal, Section Editor)
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Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Since its introduction in the USA in 2003, reverse total shoulder arthroplasty (RTSA) has been used with increasingly frequency as surgeons have observed the remarkable improvement in pain, range of motion, and function associated with this implant. RTSA was initially used exclusively for elderly, low demand individuals with end-stage rotator cuff tear arthropathy. However, RTSA is now being increasingly successfully employed for the management of irreparable rotator cuff tears, glenohumeral osteoarthritis with an intact rotator cuff, acute proximal humerus fractures, the sequelae of proximal humerus fractures, neoplasms of the proximal humerus, inflammatory arthropathy, young patients and failed anatomic total shoulder arthroplasty and hemiarthroplasty. While long-term outcomes are pending, short- and mid-term follow-up results suggest that in experienced hands, RTSA may be a reasonable treatment for many previously difficult to treat pathologies within the shoulder.

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References

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  1. Raiss P, Bruckner T, Rickert M, Walch G. Longitudinal observational study of total shoulder replacements with cement: fifteen to twenty-year follow-up. J Bone Joint Surg Am. 2014;96:198–205.

    Article  PubMed  Google Scholar 

  2. Franklin JL, Barrett WP, Jackins SE, Matsen FA. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty. 1988;3:39–46.

    Article  CAS  PubMed  Google Scholar 

  3. Flatow EL, Harrison AK. A history of reverse total shoulder arthroplasty. Clin Orthop Relat Res. 2011;469:2432–9.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elb Surg. 2005;14:147S–61.

    Article  Google Scholar 

  5. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93:2249–54.

    PubMed  Google Scholar 

  6. Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87:1697–705.

    Article  PubMed  Google Scholar 

  7. Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009;17:284–95.

    PubMed  Google Scholar 

  8. Garcia GH, Taylor SA, DePalma BJ, Mahony GT, Grawe BM, Nguyen J, et al. Patient activity levels after reverse total shoulder arthroplasty: what are patients doing? Am J Sports Med. 2015.

  9. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elb Surg. 2006;15:527–40.

    Article  Google Scholar 

  10. Nolan BM, Ankerson E, Wiater JM. Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res. 2011;469:2476–82.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Werner CML, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–86.

    Article  CAS  PubMed  Google Scholar 

  12. Seebauer L. Total reverse shoulder arthroplasty: European lessons and future trends. Am J Orthop. 2007;36:22–8.

    PubMed  Google Scholar 

  13. Affonso J, Nicholson GP, Frankle MA, Walch G, Gerber C, Garzon-Muvdi J, et al. Complications of the reverse prosthesis: prevention and treatment. Instr Course Lect. 2012;61:157–68.

    PubMed  Google Scholar 

  14. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439–49.

    PubMed  Google Scholar 

  15. Chalmers PN, Rahman Z, Romeo AA, Nicholson GP. Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2013.

  16. Gupta AK, Chalmers PN, Rahman Z, Bruce B, Harris JD, McCormick F, et al. Reverse total shoulder arthroplasty in patients of varying body mass index. J Shoulder Elb Surg. 2013.

  17. Kiet TK, Feeley BT, Naimark M, Gajiu T, Hall SL, Chung TT, et al. Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. J Shoulder Elb Surg. 2014.

  18. Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ. Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon’s experience? J Shoulder Elb Surg. 2012;21:1470–7.

    Article  Google Scholar 

  19. Renfree KJ, Hattrup SJ, Chang Y-HH. Cost utility analysis of reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2013;22:1656–61. This retrospective review of patient quality of life outcomes and treatment cost with RTSA performed for rotator cuff tear arthropathy demonstrates that RTSA is cost-effective and is on-par with total knee arthroplasty and total ankle arthroplasty in cost per quality-adjusted life-year.

    Article  Google Scholar 

  20. Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–85.

    Article  PubMed  Google Scholar 

  21. Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. 2010;92:2544–56. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=21048173&retmode=ref&cmd=prlinks.

  22. Steen BM, Cabezas AF, Santoni BG, Hussey MM, Cusick MC, Kumar AG, et al. Outcome and value of reverse shoulder arthroplasty for treatment of glenohumeral osteoarthritis: a matched cohort. J Shoulder Elb Surg. 2015.

  23. Chalmers PN, Slikker W, Mall NA, Gupta AK, Rahman Z, Enriquez D, et al. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elb Surg. 2013.

  24. Boileau P, Trojani C, Walch G, Krishnan SG, Romeo A, Sinnerton R. Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elb Surg. 2001;10:299–308.

    Article  CAS  Google Scholar 

  25. King JJ, Nystrom LM, Reimer NB, Gibbs CP, Scarborough MT, Wright TW. Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections. J Shoulder Elb Surg. 2015. This study reports the technique for reconstruction of the proximal humerus with an RTSA allograft prosthetic composite after proximal humeral oncologic resection, with specific techniques to avoid frequent complications such as instability.

  26. Young AA, Smith MM, Bacle G, Moraga C, Walch G. Early results of reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am. 2011;93:1915–23.

    PubMed  Google Scholar 

  27. Hattrup SJ, Sanchez-Sotelo J, Sperling JW, Cofield RH. Reverse shoulder replacement for patients with inflammatory arthritis. J Hand Surg. 2012;37:1888–94.

    Article  Google Scholar 

  28. Muh SJ, Streit JJ, Wanner JP, Lenarz CJ, Shishani Y, Rowland DY, et al. Early follow-up of reverse total shoulder arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am. 2013;95:1877–83. This multicenter, retrospective review of RTSA performed in patients under the age of 60 demonstrates significant improvements in range of motion and functional outcomes but with a 19 % dissatisfaction rate and an 11 % reoperation rate.

    Article  PubMed  Google Scholar 

  29. Sershon RA, Van Thiel GS, Lin EC, McGill KC, Cole BJ, Verma NN, et al. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elb Surg. 2013.

  30. Mizuno N, Denard PJ, Raiss P, Walch G. Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am. 2013;95:1297–304.

    Article  PubMed  Google Scholar 

  31. Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elb Surg. 2014;23:1419–26. This prospective, randomized clinical trial comparing RTSA and hemiarthroplasty in the treatment of proximal humeral fractures demonstrates significantly better active forward elevation, significantly better functional outcomes, and a lower revision rate in the RTSA group.

    Article  Google Scholar 

  32. Raiss P, Edwards TB, da Silva MR, Bruckner T, Loew M, Walch G. Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae). J Bone Joint Surg Am. 2014;96:2070–6. This retrospective review of outcomes of RTSA performed for surgical neck nonunion reports a 34 % rate of post-operative instability and advocates retetion and fixation of the tuberosities to avoid this issue.

    Article  PubMed  Google Scholar 

  33. De Wilde L, Boileau P, Van der Bracht H. Does reverse shoulder arthroplasty for tumors of the proximal humerus reduce impairment? Clin Orthop Relat Res. 2011;469:2489–95.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Patel DN, Young B, Onyekwelu I, Zuckerman JD, Kwon YW. Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elb Surg. 2012;21:1478–83.

    Article  Google Scholar 

  35. Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elb Surg. 2012;21:514–22.

    Article  Google Scholar 

  36. Khatib O, Onyekwelu I, Yu S, Zuckerman JD. Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization. J Shoulder Elb Surg. 2015;24:e286–91.

    Article  Google Scholar 

  37. Khatib O, Onyekwelu I, Zuckerman JD. The incidence of proximal humeral fractures in New York State from 1990 through 2010 with an emphasis on operative management in patients aged 65 years or older. J Shoulder Elb Surg. 2014.

  38. Schairer WW, Nwachukwu BU, Lyman S. National utilization of reverse total shoulder arthroplasty in the United States. J Shoulder Elb Surg. 2014.

  39. Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B. Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy. 2008;24:743–8.

    Article  PubMed  Google Scholar 

  40. Heuberer PR, Kölblinger R, Buchleitner S, Pauzenberger L, Laky B, Auffarth A, et al. Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration. Knee Surg Sports Traumatol Arthrosc. 2015.

  41. Park JG, Cho NS, Song JH, Baek JH, Rhee YG. Long-term outcome of tuberoplasty for irreparable massive rotator cuff tears: is tuberoplasty really applicable? J Shoulder Elb Surg. 2015.

  42. Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am. 2006;88:113–20.

    Article  PubMed  Google Scholar 

  43. Castricini R, Gasparini G, Di Luggo F, De Benedetto M, De Gori M, Galasso O. Health-related quality of life and functionality after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2013;22:1639–49.

    Article  Google Scholar 

  44. Flurin P-H, Marczuk Y, Janout M, Wright TW, Zuckerman J, Roche CP. Comparison of outcomes using anatomic and reverse total shoulder arthroplasty. Bull Hosp Jt Dis. 2013;71 Suppl 2:101–7.

    Google Scholar 

  45. Levy JC, Everding NG, Gil CC, Stephens S, Giveans MR. Speed of recovery after shoulder arthroplasty: a comparison of reverse and anatomic total shoulder arthroplasty. J Shoulder Elb Surg. 2014.

  46. Triplet JJ, Everding NG, Levy JC, Moor MA. Functional internal rotation after shoulder arthroplasty: a comparison of anatomic and reverse shoulder arthroplasty. J Shoulder Elb Surg. 2014.

  47. Shi LL, Cahill KE, Ek ET, Tompson JD, Higgins LD, Warner JJP. Latissimus Dorsi and Teres major transfer with reverse shoulder arthroplasty restores active motion and reduces pain for posterosuperior cuff dysfunction. Clin Orthop Relat Res. 2015;473:3212–7.

    Article  PubMed  Google Scholar 

  48. van de Sande MAJ, Rozing PM. Proximal migration can be measured accurately on standardized anteroposterior shoulder radiographs. Clin Orthop Relat Res. 2006;443:260–5.

    Article  PubMed  Google Scholar 

  49. Schoch B, Schleck C, Cofield RH, Sperling JW. Shoulder arthroplasty in patients younger than 50 years: minimum 20-year follow-up. J Shoulder Elb Surg. 2014.

  50. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14:756–60.

    Article  CAS  PubMed  Google Scholar 

  51. Walch G, Moraga C, Young A, Castellanos-Rosas J. Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elb Surg. 2012;21:1526–33.

    Article  Google Scholar 

  52. Chin PC, Hachadorian ME, Pulido PA, Munro ML, Meric G, Hoenecke HR. Outcomes of anatomic shoulder arthroplasty in primary osteoarthritis in type B glenoids. J Shoulder Elb Surg. 2015.

  53. Mizuno N, Denard PJ, Raiss P, Walch G. Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am. 2013;95:1297–304. This retrospective review demonstrates that RTSA provides reliable improvements in pain, range of motion, and function with a low re-operation rate for glenohumeral osteoarthritis with an intact rotator cuff with a B2-type glenoid and the authors advocate this as the primary treatment for this glenoid morphology over anatomic TSA.

    Article  PubMed  Google Scholar 

  54. Denard PJ, Walch G. Current concepts in the surgical management of primary glenohumeral arthritis with a biconcave glenoid. J Shoulder Elb Surg. 2013;22:1589–98.

    Article  Google Scholar 

  55. Schairer WW, Nwachukwu BU, Lyman S, Craig EV, Gulotta LV. Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elb Surg. 2015.

  56. Rosas S, Law TY, Kurowicki J, Formaini N, Kalandiak SP, Levy JC. Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012. J Shoulder Elb Surg. 2015.

  57. Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg (Br). 2007;89:516–20.

    Article  CAS  Google Scholar 

  58. Ross M, Hope B, Stokes A, Peters SE, McLeod I, Duke PFR. Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly. J Shoulder Elb Surg. 2014. This retrospective review of RTSA performed as the acute treatment of 3- and 4-part proximal humerus fractures demonstrates excellent pain relief, range of motion, and functional outcomes with a very low complication and re-operation rate.

  59. Ferrel JR, Trinh TQ, Fischer RA. Reverse total shoulder arthroplasty versus hemiarthroplasty for proximal humeral fractures: a systematic review. J Orthop Trauma. 2015;29:60–8.

    Article  PubMed  Google Scholar 

  60. Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, et al. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015;29:54–9.

    Article  PubMed  Google Scholar 

  61. Hattrup SJ, Waldrop R, Sanchez-Sotelo J. Reverse total shoulder arthroplasty for post-traumatic sequelae. J Orthop Trauma. 2015.

  62. Hussey MM, Hussey SE, Mighell MA. Reverse shoulder arthroplasty as a salvage procedure after failed internal fixation of fractures of the proximal humerus: outcomes and complications. Bone Joint J. 2015;97-B:967–72. This study reports upon 19 patients who underwent RTSA to revise da failed proximal humeral open reduction and internal fixation, with significant improvements in pain, motion, and function, but with a 21% revision rate.

  63. Kiss J, Sztrinkai G, Antal I, Kiss J, Szendroi M. Functional results and quality of life after shoulder girdle resections in musculoskeletal tumors. J Shoulder Elb Surg. 2007;16:273–9.

    Article  Google Scholar 

  64. Kaa AKS, Jørgensen PH, Søjbjerg JO, Johannsen HV. Reverse shoulder replacement after resection of the proximal humerus for bone tumours. Bone Joint J. 2013;95-B:1551–5.

    Article  CAS  PubMed  Google Scholar 

  65. Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg Am. 2012;94:685–93.

    Article  PubMed  Google Scholar 

  66. Raiss P, Schmitt M, Bruckner T, Kasten P, Pape G, Loew M, et al. Results of cemented total shoulder replacement with a minimum follow-up of ten years. J Bone Joint Surg Am. 2012;94:e1711–10.

    Article  PubMed  Google Scholar 

  67. Young A, Walch G, Boileau P, Favard L, Gohlke F, Loew M, et al. A multicentre study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis. J Bone Joint Surg (Br). 2011;93:210–6.

    Article  CAS  Google Scholar 

  68. Favard L, Katz D, Colmar M, Benkalfate T, Thomazeau H, Emily S. Total shoulder arthroplasty—arthroplasty for glenohumeral arthropathies: results and complications after a minimum follow-up of 8 years according to the type of arthroplasty and etiology. Orthop Traumatol Surg Res. 2012;98:S41–7.

    Article  CAS  PubMed  Google Scholar 

  69. Wagner E, Houdek MT, Griffith T, Elhassan BT, Sanchez-Sotelo J, Sperling JW, et al. Glenoid bone-grafting in revision to a reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2015;97:1653–60. This retrospective comparative cohort study demonstrates a 24 % 5-year revision rate for RTSA performed as a revision from a prior arthroplasty with concomitant bone grafting, which was significantly higher than RTSA without bone grafting.

    Article  PubMed  Google Scholar 

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Correspondence to Peter N. Chalmers.

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Peter N. Chalmers declares that he has no conflict of interest.

Jay D. Keener reports consultant fees from Arthrex and grants from National Institutes of Health, outside the submitted work. He is on the board of the Journal of Shoulder and Elbow Surgery.

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The work for this manuscript was performed at Washington University Medical Center in Saint Louis, MO.

This article is part of the Topical Collection on Shoulder Arthroplasty

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Chalmers, P.N., Keener, J.D. Expanding roles for reverse shoulder arthroplasty. Curr Rev Musculoskelet Med 9, 40–48 (2016). https://doi.org/10.1007/s12178-016-9316-0

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