Reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty was first introduced in Europe by Paul Grammont 20 years ago. Since then, reverse total shoulder arthroplasty has been refined and has gained popularity, especially for the treatment of rotator cuff tear arthropathy. The indications for reverse total shoulder arthroplasty now include revision arthroplasty and complex proximal humeral fractures. In contrast to standard shoulder arthroplasty procedures, which have a dynamic center of rotation, the problem of having a stable center of rotation is solved with the reverse shoulder prosthesis. By converting the humerus to a socket and the glenoid to a ball, the center of rotation is fixed at the glenohumeral joint with the reverse shoulder prosthesis. Recent research examining the biomechanical properties of the reverse prosthesis have demonstrated the importance of considering the anatomy in the region for proper placement of the glenoid component for stability and to maximize the range of motion. As more clinical trials using the reverse shoulder arthroplasty procedure become available, the complications are increasingly becoming recognized and may ultimately affect the surgical procedure itself. Orthopaedic surgeons are continuing to modify the surgical technique and design of the prosthesis to improve outcomes and have demonstrated that there is room for improvement in these areas. As the indications have expanded to include revision arthroplasty and complex proximal humeral fractures, surgeons have developed new methods to potentially improve outcomes by including latissimus dorsi transfer, proximal humeral bone grafting or glenoid bone grafting.