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'''Reverse shoulder replacement''' is a type of [[shoulder replacement]] in which the normal ball and socket relationship of [[glenohumeral joint]] is reversed, creating a more stable joint with a fixed fulcrum<ref>Walker M, Brooks J, Willis M, Frankle M. How reverse shoulder arthroplasty works. In: Clinical Orthopaedics and Related Research. Vol 469. ; 2011:2440-2451. doi:10.1007/s11999-011-1892-0.</ref>. This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates<ref>Pollock RG1, Deliz ED, McIlveen SJ, Flatow EL BL. Prosthetic replacement in rotator cuff-deficient shoulders. J Shoulder Elb Surg. 1992. doi:10.1016/1058-2746(92)90011-Q.</ref>.
'''Reverse shoulder replacement''' is a type of [[shoulder replacement]] in which the normal ball and socket relationship of [[glenohumeral joint]] is reversed, creating a more stable joint with a fixed fulcrum.<ref name=pmid21484471>{{cite journal |doi=10.1007/s11999-011-1892-0 }}</ref> This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates.<ref name=pmid22971621>{{cite journal |doi=10.1016/1058-2746(92)90011-Q }}</ref>

⚫
Originally considered a salvage procedure, the combination of improved design features and excellent clinical outcome data has led to reverse shoulder replacement largely replacing shoulder hemiarthroplasty for most indications,<ref name=pmid25958208>{{cite journal |doi=10.1016/j.jse.2015.03.018 }}</ref> and even challenging conventional anatomic shoulder replacement in many countries as the most commonly performed shoulder replacement procedure.<ref name=pmid26361437>{{cite journal |pmid=26361437 }}</ref>


⚫
Originally considered a salvage procedure, the combination of improved design features and excellent clinical outcome data has led to reverse shoulder replacement largely replacing shoulder hemiarthroplasty for most indications<ref>Schairer WW, Nwachukwu BU, Lyman S, Craig E V., Gulotta L V. Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures. J Shoulder Elb Surg. 2015;24(10):1560-1566. doi:10.1016/j.jse.2015.03.018.</ref>, and even challenging conventional anatomic shoulder replacement in many countries as the most commonly performed shoulder replacement procedure<ref>Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM. Reverse Shoulder Arthroplasty in the United States: A Comparison of National Volume, Patient Demographics, Complications, and Surgical Indications. Iowa Orthop J. 2015;35:1-7. http://www.ncbi.nlm.nih.gov/pubmed/26361437%5Cnhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4492145.</ref>.
== History ==
== History ==
Traditional shoulder replacement (known as anatomic shoulder replacement) was developed to treat glenohumeral arthritis and consists of resurfacing the native humeral head and glenoid to create smooth articular surfaces to provide pain relief and improved range of motion. Variations of this procedure have been performed as early as 1883<ref>Flatow EL, Harrison AK. A history of reverse total shoulder arthroplasty. Clin Orthop Relat Res. 2011;469(9):2432-2439. doi:10.1007/s11999-010-1733-6.</ref>. While most patients can achieve substantial clinical improvement using this approach, those with large rotator cuff tears have consistently demonstrated poor outcomes due to loss of the stability provided by these muscles<ref>Pollock RG1, Deliz ED, McIlveen SJ, Flatow EL BL. Prosthetic replacement in rotator cuff-deficient shoulders. J Shoulder Elb Surg. 1992. doi:10.1016/1058-2746(92)90011-Q.</ref>.
Traditional shoulder replacement (known as anatomic shoulder replacement) was developed to treat glenohumeral arthritis and consists of resurfacing the native humeral head and glenoid to create smooth articular surfaces to provide pain relief and improved range of motion. Variations of this procedure have been performed as early as 1883.<ref name=pmid21213090>{{cite journal |doi=10.1007/s11999-010-1733-6 }}</ref> While most patients can achieve substantial clinical improvement using this approach, those with large rotator cuff tears have consistently demonstrated poor outcomes due to loss of the stability provided by these muscles.<ref name=pmid22971621/>


In 1972, U.S. orthopedic surgeon Charles S. Neer designed a fixed-fulcrum shoulder replacement in which he reversed the ball and socket geometry<ref>CS N. Shoulder Reconstruction. Philadephia: Saunders; 1990.</ref>. Unfortunately, his design resulted in several early failures, leading him to abandon this concept. Multiple other surgeons throughout the world subsequently developed reversed ball and socket implants, and while some achieved reasonably good results<ref>Kessel L, Bayley I. Prosthetic replacement of shoulder joint: preliminary communication. J R Soc Med. 1979;72(10):748-752. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1437172&tool=pmcentrez&rendertype=abstract.</ref>, the concept never gained significant traction until French surgeon Paul Grammont developed his “Trompette” prosthesis in 1985. This was further modified into the Delta III prosthesis in 1991. As Grammont’s reverse ball and socket prosthesis gained popularity and began demonstrating reliable outcomes<ref>Grammont PM BE. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993.</ref>, he subsequently developed what would be known as the “Grammont Principles”<ref>Baulot E, Sirveaux F, Boileau P. Grammont’s idea: The story of paul grammont’s functional surgery concept and the development of the reverse principle. Clin Orthop Relat Res. 2011;469(9):2425-2431. doi:10.1007/s11999-010-1757-y.</ref>, which were a set of rules that explained why his prosthesis was effective and why other reverse ball and socket designs failed. These principles would subsequently become widely adopted throughout the world as reverse shoulder replacement gained popularity.
In 1972, U.S. orthopedic surgeon Charles S. Neer designed a fixed-fulcrum shoulder replacement in which he reversed the ball and socket geometry.<ref>CS N. Shoulder Reconstruction. Philadephia: Saunders; 1990.{{pn}}</ref> Unfortunately, his design resulted in several early failures, leading him to abandon this concept. Multiple other surgeons throughout the world subsequently developed reversed ball and socket implants, and while some achieved reasonably good results,<ref name=pmid552433>{{cite journal |pmid=552433 }}</ref> the concept never gained significant traction until French surgeon Paul Grammont developed his “Trompette” prosthesis in 1985. This was further modified into the Delta III prosthesis in 1991. As Grammont’s reverse ball and socket prosthesis gained popularity and began demonstrating reliable outcomes,<ref>Grammont PM BE. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993.{{pn}}</ref> he subsequently developed what would be known as the “Grammont Principles”,<ref name=pmid21210311>{{cite journal |doi=10.1007/s11999-010-1757-y }}</ref> which were a set of rules that explained why his prosthesis was effective and why other reverse ball and socket designs failed. These principles would subsequently become widely adopted throughout the world as reverse shoulder replacement gained popularity.

⚫
In 1998, U.S. orthopedic surgeon Mark Frankle began designing a reverse ball and socket prosthesis that did not adhere to the traditional Grammont Principles. He began patenting this device, the RSP (Reverse Shoulder Prosthesis), in 2002.<ref>Reverse shoulder prosthesis system. https://patents.google.com/patent/US6790234.</ref> Many doubted the effectiveness of his design and suggested that it would lead to higher failure rates, creating significant controversy and debate within the orthopedic community.<ref name=pmid21482152>{{cite journal |doi=10.1016/j.jse.2011.01.026 }}</ref> After validating his theories with rigorous scientific studies<ref name=pmid19047705>{{cite journal |doi=10.2106/JBJS.H.00012 }}</ref> and making several key modifications to his design,<ref name=pmid21484471/> Frankle ultimately developed an implant that was able to address the shortcomings of the Grammont-style prostheses while also showing excellent survivorship.<ref name=pmid29135662>{{cite journal |doi=10.2106/JBJS.17.00175 }}</ref> Multiple studies have since gone on to demonstrate the advantages of his design principles,<ref name=pmid29332666>{{cite journal |doi=10.1016/j.jse.2017.09.011 }}</ref><ref name=pmid28528016>{{cite journal |doi=10.1016/j.jse.2017.03.032 }}</ref> and many of the modern generation reverse shoulder implants have mirrored them.<ref name=pmid28105417>{{cite journal |doi=10.1155/2016/3256931 }}</ref>


⚫
In 1998, U.S. orthopedic surgeon Mark Frankle began designing a reverse ball and socket prosthesis that did not adhere to the traditional Grammont Principles. He began patenting this device, the RSP (Reverse Shoulder Prosthesis), in 2002<ref>Reverse shoulder prosthesis system. https://patents.google.com/patent/US6790234.</ref>. Many doubted the effectiveness of his design and suggested that it would lead to higher failure rates, creating significant controversy and debate within the orthopedic community<ref>Pupello D, Frankle M. Regarding &quot;Observations on retrieved humeral polyethylene components from reverse total shoulder arthroplasty&quot;. J shoulder Elb Surg. 2011;20(8):e22-3. doi:10.1016/j.jse.2011.01.026.</ref>. After validating his theories with rigorous scientific studies<ref>Gutiérrez S, Comiskey IV CA, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Jt Surg - Ser A. 2008;90(12):2606-2615. doi:10.2106/JBJS.H.00012.</ref> and making several key modifications to his design<ref>Walker M, Brooks J, Willis M, Frankle M. How reverse shoulder arthroplasty works. In: Clinical Orthopaedics and Related Research. Vol 469. ; 2011:2440-2451. doi:10.1007/s11999-011-1892-0.</ref>, Frankle ultimately developed an implant that was able to address the shortcomings of the Grammont-style prostheses while also showing excellent survivorship<ref>Cuff DJ, Pupello DR, Santoni BG, Clark RE, Frankle MA. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency a concise follow-up, at a minimum of 10 years, of previous reports. J Bone Jt Surg - Am Vol. 2017;99(22):1895-1899. doi:10.2106/JBJS.17.00175.</ref>. Multiple studies have since gone on to demonstrate the advantages of his design principles <ref>Keener JD, Patterson BM, Orvets N, Aleem AW, Chamberlain AM. Optimizing reverse shoulder arthroplasty component position in the setting of advanced arthritis with posterior glenoid erosion: a computer-enhanced range of motion analysis. J Shoulder Elb Surg. 2018;27(2):339-349. doi:10.1016/j.jse.2017.09.011.</ref> <ref>Werner BS, Chaoui J, Walch G. The influence of humeral neck shaft angle and glenoid lateralization on range of motion in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2017;26(10):1726-1731. doi:10.1016/j.jse.2017.03.032.</ref>, and many of the modern generation reverse shoulder implants have mirrored them <ref>Middernacht B, Van Tongel A, De Wilde L. A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty. Biomed Res Int. 2016;2016. doi:10.1155/2016/3256931.</ref>.
== Indications ==
== Indications ==
Historically, the primary indication to perform reverse shoulder replacement was cuff tear arthropathy, which consists of advanced glenohumeral arthritis in the presence of a massive rotator cuff tear<ref>Flatow EL, Harrison AK. A history of reverse total shoulder arthroplasty. Clin Orthop Relat Res. 2011;469(9):2432-2439. doi:10.1007/s11999-010-1733-6.</ref>. As reverse shoulder replacement has become more popular, the indications have expanded to include shoulder “pseudoparalysis” due to massive rotator cuff tears, shoulder fractures, severe bone loss on the scapula or humerus precluding the use of standard implants and failed prior shoulder replacement procedures<ref>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(4):514-522. doi:10.1016/j.jse.2011.03.006.</ref>.
Historically, the primary indication to perform reverse shoulder replacement was cuff tear arthropathy, which consists of advanced glenohumeral arthritis in the presence of a massive rotator cuff tear.<ref name=pmid21213090/> As reverse shoulder replacement has become more popular, the indications have expanded to include shoulder “pseudoparalysis” due to massive rotator cuff tears, shoulder fractures, severe bone loss on the scapula or humerus precluding the use of standard implants and failed prior shoulder replacement procedures.<ref name=pmid21641825>{{cite journal |doi=10.1016/j.jse.2011.03.006 }}</ref>
== Surgical techniques ==
== Surgical techniques ==
The procedure is performed through a deltopectoral approach, in which the space between the deltoid muscle and pectoralis major muscle is developed. The subscapularis muscle, one of the four muscles of the rotator cuff, is typically detached to perform the operation. The native humerus and scapula bones are prepared using precise machining to accommodate their respective implants. At the end of the procedure, the subscapularis muscle is typically repaired, although some surgeons advocate not repairing this muscle due to the excess tension placed on it by the altered mechanics of the reverse shoulder design<ref>Werner BC, Wong AC, Mahony GT, et al. Clinical Outcomes After Reverse Shoulder Arthroplasty With and Without Subscapularis Repair. J Am Acad Orthop Surg. 2018;26(5):e114-e119. doi:10.5435/JAAOS-D-16-00781.</ref>. It is worth noting that this is an implant specific phenomenon, as certain reverse shoulder designs disrupt the normal anatomical relationships significantly while others attempt to restore these closer to what is considered normal anatomy<ref>Berhouet J, Garaud P, Favard L. Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: A cadaver study. Orthop Traumatol Surg Res. 2013;99(8):887-894. doi:10.1016/j.otsr.2013.08.008.</ref>.
The procedure is performed through a deltopectoral approach, in which the space between the deltoid muscle and pectoralis major muscle is developed. The subscapularis muscle, one of the four muscles of the rotator cuff, is typically detached to perform the operation. The native humerus and scapula bones are prepared using precise machining to accommodate their respective implants. At the end of the procedure, the subscapularis muscle is typically repaired, although some surgeons advocate not repairing this muscle due to the excess tension placed on it by the altered mechanics of the reverse shoulder design.<ref name=pmid29419724>{{cite journal |doi=10.5435/JAAOS-D-16-00781 }}</ref> It is worth noting that this is an implant specific phenomenon, as certain reverse shoulder designs disrupt the normal anatomical relationships significantly while others attempt to restore these closer to what is considered normal anatomy.<ref name=pmid24211248>{{cite journal |doi=10.1016/j.otsr.2013.08.008 }}</ref>

== Implants ==
== Implants ==
Modern reverse shoulder implants consist of multiple parts. On the scapula bone, there is a metallic baseplate that grows into the bone of the native glenoid, screws and/or pegs that hold this in place, and a round metallic “glenosphere” component that is mated to the baseplate via several different mechanisms. On the humerus bone, there is typically a concave polyethylene liner that articulates with the convex glenosphere and is attached to a humeral stem that grows into the native humerus or is cemented into place. Within this basic structure there are multiple different variations of implants, and to date there is no consensus on which design is superior, although several studies have demonstrated some benefits to certain combinations<ref>Gutiérrez S, Comiskey IV CA, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Jt Surg - Ser A. 2008;90(12):2606-2615. doi:10.2106/JBJS.H.00012.</ref> <ref>Keener JD, Patterson BM, Orvets N, Aleem AW, Chamberlain AM. Optimizing reverse shoulder arthroplasty component position in the setting of advanced arthritis with posterior glenoid erosion: a computer-enhanced range of motion analysis. J Shoulder Elb Surg. 2018;27(2):339-349. doi:10.1016/j.jse.2017.09.011.</ref> <ref>Werner BS, Chaoui J, Walch G. The influence of humeral neck shaft angle and glenoid lateralization on range of motion in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2017;26(10):1726-1731. doi:10.1016/j.jse.2017.03.032.</ref>
Modern reverse shoulder implants consist of multiple parts. On the scapula bone, there is a metallic baseplate that grows into the bone of the native glenoid, screws and/or pegs that hold this in place, and a round metallic “glenosphere” component that is mated to the baseplate via several different mechanisms. On the humerus bone, there is typically a concave polyethylene liner that articulates with the convex glenosphere and is attached to a humeral stem that grows into the native humerus or is cemented into place. Within this basic structure there are multiple different variations of implants, and to date there is no consensus on which design is superior, although several studies have demonstrated some benefits to certain combinations<ref name=pmid19047705/><ref name=pmid29332666/><ref name=pmid28528016/>


== References ==
== References ==
{{reflist}}
{{Uncategorized|date=July 2018}}

Revision as of 17:12, 22 July 2018

Reverse shoulder replacement
ICD-9-CM81.80-81.81
MedlinePlus007387


Reverse shoulder replacement is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum.[1] This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates.[2]

Originally considered a salvage procedure, the combination of improved design features and excellent clinical outcome data has led to reverse shoulder replacement largely replacing shoulder hemiarthroplasty for most indications,[3] and even challenging conventional anatomic shoulder replacement in many countries as the most commonly performed shoulder replacement procedure.[4]

History

Traditional shoulder replacement (known as anatomic shoulder replacement) was developed to treat glenohumeral arthritis and consists of resurfacing the native humeral head and glenoid to create smooth articular surfaces to provide pain relief and improved range of motion. Variations of this procedure have been performed as early as 1883.[5] While most patients can achieve substantial clinical improvement using this approach, those with large rotator cuff tears have consistently demonstrated poor outcomes due to loss of the stability provided by these muscles.[2]

In 1972, U.S. orthopedic surgeon Charles S. Neer designed a fixed-fulcrum shoulder replacement in which he reversed the ball and socket geometry.[6] Unfortunately, his design resulted in several early failures, leading him to abandon this concept. Multiple other surgeons throughout the world subsequently developed reversed ball and socket implants, and while some achieved reasonably good results,[7] the concept never gained significant traction until French surgeon Paul Grammont developed his “Trompette” prosthesis in 1985. This was further modified into the Delta III prosthesis in 1991. As Grammont’s reverse ball and socket prosthesis gained popularity and began demonstrating reliable outcomes,[8] he subsequently developed what would be known as the “Grammont Principles”,[9] which were a set of rules that explained why his prosthesis was effective and why other reverse ball and socket designs failed. These principles would subsequently become widely adopted throughout the world as reverse shoulder replacement gained popularity.

In 1998, U.S. orthopedic surgeon Mark Frankle began designing a reverse ball and socket prosthesis that did not adhere to the traditional Grammont Principles. He began patenting this device, the RSP (Reverse Shoulder Prosthesis), in 2002.[10] Many doubted the effectiveness of his design and suggested that it would lead to higher failure rates, creating significant controversy and debate within the orthopedic community.[11] After validating his theories with rigorous scientific studies[12] and making several key modifications to his design,[1] Frankle ultimately developed an implant that was able to address the shortcomings of the Grammont-style prostheses while also showing excellent survivorship.[13] Multiple studies have since gone on to demonstrate the advantages of his design principles,[14][15] and many of the modern generation reverse shoulder implants have mirrored them.[16]

Indications

Historically, the primary indication to perform reverse shoulder replacement was cuff tear arthropathy, which consists of advanced glenohumeral arthritis in the presence of a massive rotator cuff tear.[5] As reverse shoulder replacement has become more popular, the indications have expanded to include shoulder “pseudoparalysis” due to massive rotator cuff tears, shoulder fractures, severe bone loss on the scapula or humerus precluding the use of standard implants and failed prior shoulder replacement procedures.[17]

Surgical techniques

The procedure is performed through a deltopectoral approach, in which the space between the deltoid muscle and pectoralis major muscle is developed. The subscapularis muscle, one of the four muscles of the rotator cuff, is typically detached to perform the operation. The native humerus and scapula bones are prepared using precise machining to accommodate their respective implants. At the end of the procedure, the subscapularis muscle is typically repaired, although some surgeons advocate not repairing this muscle due to the excess tension placed on it by the altered mechanics of the reverse shoulder design.[18] It is worth noting that this is an implant specific phenomenon, as certain reverse shoulder designs disrupt the normal anatomical relationships significantly while others attempt to restore these closer to what is considered normal anatomy.[19]

Implants

Modern reverse shoulder implants consist of multiple parts. On the scapula bone, there is a metallic baseplate that grows into the bone of the native glenoid, screws and/or pegs that hold this in place, and a round metallic “glenosphere” component that is mated to the baseplate via several different mechanisms. On the humerus bone, there is typically a concave polyethylene liner that articulates with the convex glenosphere and is attached to a humeral stem that grows into the native humerus or is cemented into place. Within this basic structure there are multiple different variations of implants, and to date there is no consensus on which design is superior, although several studies have demonstrated some benefits to certain combinations[12][14][15]

References

  1. ^ a b . doi:10.1007/s11999-011-1892-0. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  2. ^ a b . doi:10.1016/1058-2746(92)90011-Q. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  3. ^ . doi:10.1016/j.jse.2015.03.018. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  4. ^ . PMID 26361437. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  5. ^ a b . doi:10.1007/s11999-010-1733-6. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  6. ^ CS N. Shoulder Reconstruction. Philadephia: Saunders; 1990.[page needed]
  7. ^ . PMID 552433. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  8. ^ Grammont PM BE. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993.[page needed]
  9. ^ . doi:10.1007/s11999-010-1757-y. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  10. ^ Reverse shoulder prosthesis system. https://patents.google.com/patent/US6790234.
  11. ^ . doi:10.1016/j.jse.2011.01.026. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  12. ^ a b . doi:10.2106/JBJS.H.00012. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  13. ^ . doi:10.2106/JBJS.17.00175. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  14. ^ a b . doi:10.1016/j.jse.2017.09.011. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  15. ^ a b . doi:10.1016/j.jse.2017.03.032. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  16. ^ . doi:10.1155/2016/3256931. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)CS1 maint: unflagged free DOI (link)
  17. ^ . doi:10.1016/j.jse.2011.03.006. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  18. ^ . doi:10.5435/JAAOS-D-16-00781. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  19. ^ . doi:10.1016/j.otsr.2013.08.008. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
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