The SMR reverse shoulder prosthesis in the treatment of cuff-deficient shoulder conditions

Background: Reverse total shoulder arthroplasty (RSA) is a relatively recent concept that provides further options in the management of cuff-deficient shoulder disorders. While early results utilizing the Delta fit prosthesis (DePuy, Warsaw. IN) have been promising, there is limited data in the literature on outcomes utilizing differing prosthetic designs. We report on the outcomes of Reverse total shoulder arthroplasty (RSA) utilizing a previously unreported prosthesis, the SMR Modular Shoulder System (Systema Multiplana Randelli, Lima-LTO, Italy). Material and methods: 49 arthroplasties in 48 patients who underwent Reverse Shoulder Arthroplasty with the SMR prosthesis were available for follow up. There were 10 males and 38 females with a mean age of 78.9 years (55-94) at time of operation. The most common indications were cuff tear arthropathy and osteoarthritis with cuff deficiency (66%), followed by fracture and fracture sequelae (16%). Results: At a mean 38 months follow up, 89% of patients rated their outcome as good or excellent. The mean American Shoulder and Elbow Surgeon Score was 70.1 (range 3-100), and the mean Oxford Shoulder Score 22.0 (12-47). The mean active anterior elevation was 122 degrees (range 45-180) and the mean external rotation 14.7 degrees (25-75). Interior glenoid notching was seen in 24% of patients. There was no radiological evidence of component loosening and no reoperations. Conclusion: Modern RSA designs give encouraging results in the treatment of cuff deficient shoulder conditions. Our early experience with the SMR RSA shows favourable outcomes and a low rate of complications. Level of evidence: Level 4; Retrospective case series. no control group. (C) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.