Reverse Shoulder Arthroplasty | Rotator Cuff Arthropathy

In this video, reverse shoulder arthroplasty is discussed and demonstrated. Rotator cuff arthroplasty results in pain and weakness with poor active motion. Absence or weakness of the rotator cuff causes proximal humeral head migration from the pull of the deltoid muscle, which can result in superior glenoid erosion. Radiographs demonstrate superior humeral migration, superior glenoid eburnation and acromial "acetabularization". 3-D imaging is helpful to evalute for version and inclination of the glenoid so that the implant can be placed properly and securely.

Rotator cuff arthropathy originally treated with hermiarthroplasty. Although this diminshed pain, poor active forward elevation remained. Rotator cuff insufficiency is also a relative contra-indication for shoulder arthorplasty, and superior eccentric loading of glenoid component, which may result in loosening and failure.

Originally designed by Gurmount in 1982, reverse shoulder arthroplasty has several advantages over other methods of treatment. Specifically, procedure results in medialization and distalization of the center location of the glenohumeral joint. This creates a fixed fulcrum allowing the deltoid to substitute for a deficient rotator cuff.

Reverse total shoulder arthroplasty:

- Center of rotation medialized and distalized
- Deltoid substitues for dificient rotator cuff
- Restores active forward elevation

The indications for reverse shoulder arthrosplasty include:

- Nonfunctional rotator cuff
- Rotator cuff tear arthropathy, pseudoparalysis
- Some fractures
- Failed hemiarthroplasty


Contraindications for reverse shoulder arthroplasty include:

- Deltoid dysfunction
- Neuroarthropathy
- Parkinson's Disease
- Poor glenoid bone stock
- Individuals who participate in high-demand activities

This surgical case demonstrates a reverse shoulder arthroplasty. The preferred technique is a deltopectoral approach with baseplate tilted 15 degrees inferiorly. The humeral stem placed to match glenosphere version. Slightly increased tension of deltoid and conjoined tendon.

Immediately post-operatively, the patient is placed in a sling. Passive range of motion is begun immediately. Active-assisted and active range of motion is started at 3 weeks with a slow progression to full range of motion. 90/90 stretching is limited until 4-6 weeks. Strengthening is begun at 4-6 weeks emphasizing deltoid strength in all planes.

Although uncommon, complications following reverse shoulder arthroplasty do occur. The most common finding is scapular notching and instability which can usually be managed non-operatively with a closed reduction. Baseplate failure/loosening, dissociation of modular components, fractures and neurovascular injury are other complications that can occur.