Reverse total shoulder arthroplasty
Updates to Article Attributes
Reverse total shoulder arthroplasty (RTSA) is a type of total shoulder replacement. It is often the preferred method when there has been advanced damage to the rotator cuff as seen in rotator cuff arthropathy.
Procedure
The reverse total shoulder flips the normal mechanical arrangement of the shoulder's ball and socket-and-socket joint. Instead of the humeral head fitting into the glenoid, a rounded hemispheric glenoid prosthesis articulates with a socket on the humeral head prosthesis.
Advantages/disadvantages
Because of the different mechanical arrangement of the shoulder joint, the deltoid muscle provides most of the movement for the upper extremity after the surgery. Rotator cuff muscles are not as necessary to move the upper extremity, which is preferable in patients with advanced rotator cuff damage. Internal and external rotation are more limited in this arrangement, however.
The indications for reverse total shoulder replacement are expanding and include replacement after tumour surgery and after complex fractures in elderly patients.
The design is thought to have relatively good short and medium-term outcomes compared with other types of total shoulder replacements, with improved recovery time and pain scores 3. Long-term outcomes are not yet well-defined.
Radiographic features
Conventional radiographyPlain radiograph
- neutral AP view (Grashey view) and axillary views obtained
- >2 mm of lucency around the prosthetic component is concerning for loosening
- "scapular notching" (erosion of the inferior scapular neck) is suggestive of glenoid component failure
- periprosthetic fractures at the base of the acromion at the scapular spine are more common
CT
- better for evaluation if there is a suboptimal radiograph
- as on conventionsl radigraphy, >2 mm of lucency around the prosthetic component is concerning for loosening
MRI
- metal reduction techniques have improved the ability to image prostheses on MRI
Ultrasound
- useful for imaging the rotator cuff musculature, evaluating the prosthesis dynamically, and evaluating for joint effusion
- cannot be used to evaluate for component loosening
Complications
The overall complication rate for all forms of total shoulder arthroplasty is ~15%. Complications include:
- aseptic loosening of the glenoid component: most common complication (~32% of all shoulder replacements, but decreased with reverse total shoulder replacements 5)
- aseptic loosening of the humeral component
- dislocation
- periprosthetic fractures
- hardware failure
- axillary nerve palsy
- infection (uncommon)
-<p><strong>Reverse total shoulder arthroplasty (RTSA) </strong>is a type of <a href="/articles/total-shoulder-replacement">total shoulder replacement</a>. It is often the preferred method when there has been advanced damage to the <a href="/articles/rotator-cuff">rotator cuff</a> as seen in <a href="/articles/rotator-cuff-arthropathy">rotator cuff arthropathy</a>.</p><h4>Procedure</h4><p>The reverse total shoulder flips the normal mechanical arrangement of the shoulder's ball and socket joint. Instead of the humeral head fitting into the glenoid, a rounded hemispheric glenoid prosthesis articulates with a socket on the humeral head prosthesis.</p><h4>Advantages/disadvantages</h4><p>Because of the different mechanical arrangement of the shoulder joint, the <a href="/articles/deltoid-muscle">deltoid muscle</a> provides most of the movement for the upper extremity after the surgery. Rotator cuff muscles are not as necessary to move the upper extremity, which is preferable in patients with advanced rotator cuff damage. Internal and external rotation are more limited in this arrangement, however.</p><p>The indications for reverse total shoulder replacement are expanding and include replacement after tumour surgery and after complex fractures in elderly patients.</p><p>The design is thought to have relatively good short and medium-term outcomes compared with other types of total shoulder replacements, with improved recovery time and pain scores <sup>3</sup>. Long-term outcomes are not yet well-defined.</p><h4>Radiographic features</h4><h5>Conventional radiography</h5><ul>- +<p><strong>Reverse total shoulder arthroplasty (RTSA) </strong>is a type of <a href="/articles/total-shoulder-replacement">total shoulder replacement</a>. It is often the preferred method when there has been advanced damage to the <a href="/articles/rotator-cuff">rotator cuff</a> as seen in <a href="/articles/rotator-cuff-arthropathy">rotator cuff arthropathy</a>.</p><h4>Procedure</h4><p>The reverse total shoulder flips the normal mechanical arrangement of the shoulder's ball-and-socket joint. Instead of the humeral head fitting into the glenoid, a rounded hemispheric glenoid prosthesis articulates with a socket on the humeral head prosthesis.</p><h4>Advantages/disadvantages</h4><p>Because of the different mechanical arrangement of the shoulder joint, the <a href="/articles/deltoid-muscle">deltoid muscle</a> provides most of the movement for the upper extremity after the surgery. Rotator cuff muscles are not as necessary to move the upper extremity, which is preferable in patients with advanced rotator cuff damage. Internal and external rotation are more limited in this arrangement, however.</p><p>The indications for reverse total shoulder replacement are expanding and include replacement after tumour surgery and after complex fractures in elderly patients.</p><p>The design is thought to have relatively good short and medium-term outcomes compared with other types of total shoulder replacements, with improved recovery time and pain scores <sup>3</sup>. Long-term outcomes are not yet well-defined.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul>