Reverse total shoulder arthroplasty

Changed by Matt A. Morgan, 23 Feb 2018
Back to revision history

Updates to Article Attributes

Body was changed:

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 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

Reversing the ball and socket arrangement, the point of rotation is moved more medially, aiding the deltoid muscle which, without an intact rotator cuff with, will provide most of the early adduction for the upper extremity after the surgery. 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

Plain 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 radigraphyconventional radiography, >2 mm of lucency around the prosthetic component is concerning for loosening
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)
  • acromion stress fracture
  • -<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>Reversing the ball and socket arrangement, the point of rotation is moved more medially aiding the <a href="/articles/deltoid-muscle">deltoid muscle</a> which, without an intact rotator cuff with provide most of the early adduction for the upper extremity after the surgery. 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>
  • +<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>Reversing the ball and socket arrangement, the point of rotation is moved more medially, aiding the <a href="/articles/deltoid-muscle">deltoid muscle</a> which, without an intact rotator cuff, will provide most of the early adduction for the upper extremity after the surgery. 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>
  • -<li>as on conventionsl radigraphy, &gt;2 mm of lucency around the prosthetic component is concerning for loosening</li>
  • +<li>as on conventional radiography, &gt;2 mm of lucency around the prosthetic component is concerning for loosening</li>

ADVERTISEMENT: Supporters see fewer/no ads