Clin Orthop Surg.  2013 Dec;5(4):243-255. 10.4055/cios.2013.5.4.243.

Uncommon Indications for Reverse Total Shoulder Arthroplasty

• Hyun YS
• Huri G
• Garbis NG
• McFarland

• KMID: 1787026
• DOI: http://doi.org/10.4055/cios.2013.5.4.243

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.

Keyword

Shoulder; Arthroplasty; Arthritis; Fractures; Surgery

MeSH Terms

*Arthroplasty, Replacement
Humans
Range of Motion, Articular
Rotator Cuff/*surgery
Shoulder Fractures/diagnosis/physiopathology/*surgery
Shoulder Joint/*surgery

Figure

• 

  Fig. 1 A 78-year-old male patient with massive rotator cuff tear without arthritis. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows proximal migration of the humeral head without glenohumeral arthritic change. (B) Conventional anteroposterior radiograph of the shoulder at 12 months' follow-up shows satisfactory positioning of the prosthesis with no signs of loosening. (C) Preoperative clinical picture shows active arm elevation at less than 90°. (D) Postoperative clinical picture shows active arm elevation was improved at 12 months' follow-up.

• 

  Fig. 2 A 74-year-old female patient with proximal humeral fracture. (A) Preoperative shoulder conventional anteroposterior radiograph of the shoulder shows severe comminuted proximal humeral fracture. (B) Conventional anteroposterior radiograph at 14 months' follow-up shows a well-fixed prosthesis.

• 

  Fig. 3 A 78-year-old female patient with proximal malunited fracture. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows distorted greater tuberosity (arrow head) and inferior part of humeral head (arrow). (B) Preoperative axillary radiograph of the shoulder also shows distorted alignment between the head and shaft. (C) Conventional anteroposterior radiograph of the shoulder at 2 years' follow-up shows a well-fixed prosthesis.

• 

  Fig. 4 A 53-year-old male patient with osteoarthritis with glenoid bone loss. (A) Preoperative conventional anteroposterior radiograph of the shoulder and (B) preoperative conventional axillary radiograph of the shoulder show severe bony erosion of posterior glenoid (arrow). Postoperative conventional shoulder radiographs at 25 months' follow-up show a well-fixed prosthesis: (C) anteroposterior view, and (D) axillary view.

• 

  Fig. 5 A 44-year-old female patient with glenoid dysplasia. (A) Preoperative conventional anteroposterior radiograph of the shoulder showing the altered glenoid anatomy, consistent with dysplasia. (B) Preoperative computed tomography scan, axial cut shows narrowed joint space and severely distorted articular surfaces of head and glenoid (dotted circle). Conventional radiographs of the shoulder at 6 months' follow-up show a well-fixed prosthesis: (C) anteroposterior view, and (D) axillary view.

• 

  Fig. 6 A 42-year-old female patient with chronic locked anterior dislocation. The anteroposterior (A) and axillary (B) preoperative conventional radiographs of the shoulder show a severe engaged Hill-Sachs lesion (multiple arrows) and unreduced chronic anterior dislocation. (C) Conventional anteroposterior radiograph of the shoulder at 8 months' follow-up shows a well-fixed prosthesis.

• 

  Fig. 7 A 47-year-old female patient with rheumatoid arthritis. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows severely eroded articular surfaces of glenoid and humeral head. (B) Conventional anteroposterior radiograph of the shoulder at 4 months' follow-up shows a well-fixed prosthesis.

• 

  Fig. 8 A 47-year-old female patient with history of failed rotator cuff repair. (A) Preoperative conventional anteroposterior radiograph of the shoulder shows proximal migration of the humeral head. (B) Preoperative conventional axillary radiograph of the shoulder shows the humeral head has migrated anteriorly. (C) Deltoid atrophy (arrow) was evident in the preoperative physical examination. Conventional radiographs at 1 month follow-up show a well-fixed prosthesis: (D) anteroposterior view, and (E) axillary view.

Reference

1. Nolan BM, Ankerson E, Wiater JM. Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res. 2011; 469(9):2476–2482.

2. Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009; 17(5):284–295.

3. Khan WS, Longo UG, Ahrens PM, Denaro V, Maffulli N. A systematic review of the reverse shoulder replacement in rotator cuff arthropathy, rotator cuff tears, and rheumatoid arthritis. Sports Med Arthrosc. 2011; 19(4):366–379.

4. Wall B, Nove-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(7):1476–1485.

5. Affonso J, Nicholson GP, Frankle MA, et al. Complications of the reverse prosthesis: prevention and treatment. Instr Course Lect. 2012; 61:157–168.

6. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011; 19(7):439–449.

7. Drake GN, O'Connor DP, Edwards TB. Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res. 2010; 468(6):1526–1533.

8. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty: survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006; 88(8):1742–1747.

9. Feeley BT, Gallo RA, Craig EV. Cuff tear arthropathy: current trends in diagnosis and surgical management. J Shoulder Elbow Surg. 2009; 18(3):484–494.

10. Harreld KL, Puskas BL, Frankle MA. Massive rotator cuff tears without arthropathy: when to consider reverse shoulder arthroplasty. Instr Course Lect. 2012; 61:143–156.

11. Austin L, Zmistowski B, Chang ES, Williams GR Jr. Is reverse shoulder arthroplasty a reasonable alternative for revision arthroplasty? Clin Orthop Relat Res. 2011; 469(9):2531–2537.

12. Smith CD, Guyver P, Bunker TD. Indications for reverse shoulder replacement: a systematic review. J Bone Joint Surg Br. 2012; 94(5):577–583.

13. Cofield RH. Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am. 1984; 66(6):899–906.

14. Neer CS II, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982; 64(3):319–337.

15. Torchia ME, Cofield RH, Settergren CR. Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg. 1997; 6(6):495–505.

16. Edwards TB, Boulahia A, Kempf JF, Boileau P, Nemoz C, Walch G. The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study. J Bone Joint Surg Am. 2002; 84(12):2240–2248.

17. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005; 14:1 Suppl S. 147S–161S.

18. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993; 16(1):65–68.

19. De Wilde LF, Audenaert EA, Berghs BM. Shoulder prostheses treating cuff tear arthropathy: a comparative biomechanical study. J Orthop Res. 2004; 22(6):1222–1230.

20. Boileau P, Gonzalez JF, Chuinard C, Bicknell R, Walch G. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg. 2009; 18(4):600–606.

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. J Bone Joint Surg Am. 2010; 92(15):2544–2556.

22. Neer CS II. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970; 52(6):1090–1103.

23. Bastian JD, Hertel R. Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elbow Surg. 2009; 18(2):216–219.

24. Antuna SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg. 2008; 17(2):202–209.

25. Noyes MP, Kleinhenz B, Markert RJ, Crosby LA. Functional and radiographic long-term outcomes of hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. 2011; 20(3):372–377.

26. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002; 11(5):401–412.

27. Compito CA, Self EB, Bigliani LU. Arthroplasty and acute shoulder trauma: reasons for success and failure. Clin Orthop Relat Res. 1994; (307):27–36.

28. Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R. Is reverse shoulder arthroplasty appropriate for the treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res. 2011; 469(12):3324–3331.

29. Mighell MA, Kolm GP, Collinge CA, Frankle MA. Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elbow Surg. 2003; 12(6):569–577.

30. Boyle MJ, Youn SM, Frampton CM, Ball CM. Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg. 2013; 22(1):32–37.

31. 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(4):516–520.

32. Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br. 2010; 92(4):535–539.

33. Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res. 2009; 95(1):48–55.

34. Garrigues GE, Johnston PS, Pepe MD, Tucker BS, Ramsey ML, Austin LS. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics. 2012; 35(5):e703–e708.

35. Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma. 2008; 22(10):698–704.

36. Young SW, Segal BS, Turner PC, Poon PC. Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. ANZ J Surg. 2010; 80(11):789–793.

37. Cazeneuve JF, Cristofari DJ. Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2006; 92(6):543–548.

38. Willis M, Min W, Brooks JP, et al. Proximal humeral malunion treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21(4):507–513.

39. Barrett WP, Franklin JL, Jackins SE, Wyss CR, Matsen FA 3rd. Total shoulder arthroplasty. J Bone Joint Surg Am. 1987; 69(6):865–872.

40. Franklin JL, Barrett WP, Jackins SE, Matsen FA 3rd. Glenoid loosening in total shoulder arthroplasty: association with rotator cuff deficiency. J Arthroplasty. 1988; 3(1):39–46.

41. Antuna SA, Sperling JW, Sanchez-Sotelo J, Cofield RH. Shoulder arthroplasty for proximal humeral malunions: long-term results. J Shoulder Elbow Surg. 2002; 11(2):122–129.

42. Boileau P, Chuinard C, Le Huec JC, Walch G, Trojani C. Proximal humerus fracture sequelae: impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res. 2006; 442:121–130.

43. Boileau P, Neyton L. Reverse shoulder arthroplasty in proximal humerus fracture sequelae: constrained or nonconstrained prosthesis. In : Boileau P, Walch G, Mole D, editors. Shoulder concepts 2008: proximal humeral fractures & fracture sequelae. Montpellier, France: Sauramps Medical;2008. p. 265–269.

44. 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 Elbow Surg. 2001; 10(4):299–308.

45. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987; (214):160–164.

46. Kilic M, Berth A, Blatter G, et al. Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral head. Acta Orthop Traumatol Turc. 2010; 44(6):417–425.

47. Martinez AA, Calvo A, Bejarano C, Carbonel I, Herrera A. The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus. J Orthop Sci. 2012; 17(2):141–147.

48. Beran MC, Donaldson CT, Bishop JY. Treatment of chronic glenoid defects in the setting of recurrent anterior shoulder instability: a systematic review. J Shoulder Elbow Surg. 2010; 19(5):769–780.

49. Holcomb JO, Hebert DJ, Mighell MA, et al. Reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Shoulder Elbow Surg. 2010; 19(7):1076–1084.

50. Neyton L, Boileau P, Nove-Josserand L, Edwards TB, Walch G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007; 16:3 Suppl. S71–S78.

51. Strauss EJ, Roche C, Flurin PH, Wright T, Zuckerman JD. The glenoid in shoulder arthroplasty. J Shoulder Elbow Surg. 2009; 18(5):819–833.

52. Boileau P, Moineau G, Roussanne Y, O'Shea K. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011; 469(9):2558–2567.

53. Cofield RH. Bone grafting for glenoid bone deficiencies in shoulder arthritis: a review. J Shoulder Elbow Surg. 2007; 16:5 Suppl. S273–S281.

54. Neyton L, Walch G, Nove-Josserand L, Edwards TB. Glenoid corticocancellous bone grafting after glenoid component removal in the treatment of glenoid loosening. J Shoulder Elbow Surg. 2006; 15(2):173–179.

55. Sears BW, Johnston PS, Ramsey ML, Williams GR. Glenoid bone loss in primary total shoulder arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2012; 20(9):604–613.

56. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999; 14(6):756–760.

57. Bateman E, Donald SM. Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results. J Shoulder Elbow Surg. 2012; 21(7):925–934.

58. Wirth MA, Lyons FR, Rockwood CA Jr. Hypoplasia of the glenoid: a review of sixteen patients. J Bone Joint Surg Am. 1993; 75(8):1175–1184.

59. Edwards TB, Boulahia A, Kempf JF, Boileau P, Nemoz C, Walch G. Shoulder arthroplasty in patients with osteoarthritis and dysplastic glenoid morphology. J Shoulder Elbow Surg. 2004; 13(1):1–4.

60. Sahajpal DT, Zuckerman JD. Chronic glenohumeral dislocation. J Am Acad Orthop Surg. 2008; 16(7):385–398.

61. Sperling JW, Cofield RH, Schleck CD, Harmsen WS. Total shoulder arthroplasty versus hemiarthroplasty for rheumatoid arthritis of the shoulder: results of 303 consecutive cases. J Shoulder Elbow Surg. 2007; 16(6):683–690.

62. Cicak N. Posterior dislocation of the shoulder. J Bone Joint Surg Br. 2004; 86(3):324–332.

63. Checchia SL, Santos PD, Miyazaki AN. Surgical treatment of acute and chronic posterior fracture-dislocation of the shoulder. J Shoulder Elbow Surg. 1998; 7(1):53–65.

64. Cheng SL, Mackay MB, Richards RR. Treatment of locked posterior fracture-dislocations of the shoulder by total shoulder arthroplasty. J Shoulder Elbow Surg. 1997; 6(1):11–17.

65. Pritchett JW, Clark JM. Prosthetic replacement for chronic unreduced dislocations of the shoulder. Clin Orthop Relat Res. 1987; (216):89–93.

66. Sperling JW, Pring M, Antuna SA, Cofield RH. Shoulder arthroplasty for locked posterior dislocation of the shoulder. J Shoulder Elbow Surg. 2004; 13(5):522–527.

67. Betts HM, Abu-Rajab R, Nunn T, Brooksbank AJ. Total shoulder replacement in rheumatoid disease: a 16- to 23-year follow-up. J Bone Joint Surg Br. 2009; 91(9):1197–1200.

68. Boyd AD Jr, Thomas WH, Scott RD, Sledge CB, Thornhill TS. Total shoulder arthroplasty versus hemiarthroplasty: indications for glenoid resurfacing. J Arthroplasty. 1990; 5(4):329–336.

69. Sneppen O, Fruensgaard S, Johannsen HV, Olsen BS, Sojbjerg JO, Andersen NH. Total shoulder replacement in rheumatoid arthritis: proximal migration and loosening. J Shoulder Elbow Surg. 1996; 5(1):47–52.

70. Trail IA, Nuttall D. The results of shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Br. 2002; 84(8):1121–1125.

71. 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(20):1915–1923.

72. Khan A, Bunker TD, Kitson JB. Clinical and radiological follow-up of the Aequalis third-generation cemented total shoulder replacement: a minimum ten-year study. J Bone Joint Surg Br. 2009; 91(12):1594–1600.

73. Stewart MP, Kelly IG. Total shoulder replacement in rheumatoid disease: 7- to 13-year follow-up of 37 joints. J Bone Joint Surg Br. 1997; 79(1):68–72.

74. Lehtinen JT, Belt EA, Lyback CO, et al. Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders. J Shoulder Elbow Surg. 2000; 9(3):183–187.

75. Ekelund A, Nyberg R. Can reverse shoulder arthroplasty be used with few complications in rheumatoid arthritis? Clin Orthop Relat Res. 2011; 469(9):2483–2488.

76. Rittmeister M, Kerschbaumer F. Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg. 2001; 10(1):17–22.

77. Woodruff MJ, Cohen AP, Bradley JG. Arthroplasty of the shoulder in rheumatoid arthritis with rotator cuff dysfunction. Int Orthop. 2003; 27(1):7–10.

78. Werner CM, 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(7):1476–1486.

79. Goel DP, Ross DC, Drosdowech DS. Rotator cuff tear arthropathy and deltoid avulsion treated with reverse total shoulder arthroplasty and latissimus dorsi transfer: case report and review of the literature. J Shoulder Elbow Surg. 2012; 21(5):e1–e7.

80. Tay AK, Collin P. Irreparable spontaneous deltoid rupture in rotator cuff arthropathy: the use of a reverse total shoulder replacement. J Shoulder Elbow Surg. 2011; 20(7):e5–e8.

81. Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res. 2011; 469(9):2469–2475.