Reverse shoulder replacement

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Reverse shoulder replacement
Right RSP Monoblock.jpg
Plain film radiograph in anteroposterior (AP) view of a right shoulder status post reverse shoulder arthroplasty using a prosthesis with a lateralized center of rotation.
ICD-9-CM 81.80-81.81
MedlinePlus 007387

Reverse shoulder replacement is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum. [1] This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates. [2]

Contents

Originally considered a salvage procedure, the combination of improved design features and excellent clinical outcome data has led to reverse shoulder replacement largely replacing shoulder hemiarthroplasty for most indications, [3] and even challenging conventional anatomic shoulder replacement in many countries as the most commonly performed shoulder replacement procedure. [4]

Medical uses

Historically, the primary indication to perform reverse shoulder replacement was cuff tear arthropathy, which consists of advanced glenohumeral arthritis in the presence of a massive rotator cuff tear. [5] As reverse shoulder replacement has become more popular, the indications have expanded to include shoulder “pseudoparalysis” due to massive rotator cuff tears, shoulder fractures, severe bone loss on the scapula or humerus precluding the use of standard implants and failed prior shoulder replacement procedures. [6] More recently, reverse shoulder replacement has increasingly been used for patients with osteoarthritis with intact rotator cuff tendons, and research has shown similar outcomes to the traditional anatomical total shoulder replacement. [7]

Surgical techniques

Pectoralis major muscle Gray410.png
Pectoralis major muscle

The procedure is performed through a deltopectoral approach, in which the space between the deltoid muscle and pectoralis major muscle is developed. The subscapularis muscle, one of the four muscles of the rotator cuff, is typically detached to perform the operation. The native humerus and scapula bones are prepared using precise machining to accommodate their respective implants. At the end of the procedure, the subscapularis muscle is typically repaired, although some surgeons advocate not repairing this muscle due to the excess tension placed on it by the altered mechanics of the reverse shoulder design. [8]

It is worth noting that this is an implant specific phenomenon, as certain reverse shoulder designs disrupt the normal anatomical relationships significantly while others attempt to restore these closer to what is considered normal anatomy. [9]

Implants

Modern reverse shoulder implants consist of multiple parts. On the scapula bone, there is a metallic baseplate that grows into the bone of the native glenoid, screws and/or pegs that hold this in place, and a round metallic “glenosphere” component that is mated to the baseplate via several different mechanisms. On the humerus bone, there is typically a concave polyethylene liner that articulates with the convex glenosphere and is attached to a humeral stem that grows into the native humerus or is cemented into place. Within this basic structure there are multiple different variations of implants, and to date there is no consensus on which design is superior, although several studies have demonstrated some benefits to certain combinations. [10] [11] [12]

Plain film radiographs in anteroposterior (AP) view of left shoulders that are status post reverse shoulder arthroplasty using three design iterations each with a 135-degree neck-shaft angle and lateralized center of rotation. 3 Designs of Reverse Shoulder Arthroplasty Prostheses RSP to Monoblock to AltiVate.jpg
Plain film radiographs in anteroposterior (AP) view of left shoulders that are status post reverse shoulder arthroplasty using three design iterations each with a 135-degree neck-shaft angle and lateralized center of rotation.

History

Traditional shoulder replacement (known as anatomic shoulder replacement) was developed to treat glenohumeral arthritis and consists of resurfacing the native humeral head and glenoid to create smooth articular surfaces to provide pain relief and improved range of motion. Variations of this procedure have been performed as early as 1883. [5] While most patients can achieve substantial clinical improvement using this approach, those with large rotator cuff tears have consistently demonstrated poor outcomes due to loss of the stability provided by these muscles. [2]

In 1972, U.S. orthopedic surgeon Charles S. Neer designed a fixed-fulcrum shoulder replacement in which he reversed the ball and socket geometry. [13] His design resulted in several early failures, leading him to abandon this concept. Multiple other surgeons throughout the world subsequently developed reversed ball and socket implants, and while some achieved reasonably good results, [14] the concept never gained significant traction until French surgeon Paul Grammont developed his “Trompette” prosthesis in 1985. This was further modified into the Delta III prosthesis in 1991. As Grammont's reverse ball and socket prosthesis gained popularity and began demonstrating reliable outcomes, [15] he subsequently developed what would be known as the “Grammont Principles”, [16] which were a set of rules that explained why his prosthesis was effective and why other reverse ball and socket designs failed.[ citation needed ]

In 1998, U.S. orthopedic surgeon Mark Frankle began designing a reverse ball and socket prosthesis that did not adhere to the traditional Grammont Principles. He began patenting this device, the RSP (Reverse Shoulder Prosthesis), in 2002. [17] Many doubted the effectiveness of his design and suggested that it would lead to higher failure rates, creating significant controversy and debate within the orthopedic community. [18] After validating his theories with rigorous scientific studies [10] and making several key modifications to his design, [1] Frankle ultimately developed an implant that was able to address the shortcomings of the Grammont-style prostheses while also showing excellent survivorship. [19] Multiple studies have since gone on to demonstrate the advantages of his design principles, [20] [11] [12] and many of the modern generation reverse shoulder implants have mirrored them. [21]

With good outcome in rotator cuff arthropathy, the indications for performing reverse shoulder arthroplasty has also expanded to all the situations where the rotator cuff function will be compromised such as unreconstructible fractures of proximal humerus, fracture sequelae, revision shoulder arthroplasty, shoulder instability along with arthritis and proximal humerus bone tumours.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Rotator cuff</span> Group of muscles

The rotator cuff is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are:

<span class="mw-page-title-main">Shoulder problem</span> Medical condition

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

<span class="mw-page-title-main">Shoulder</span> Part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons.

<span class="mw-page-title-main">Deltoid muscle</span> Shoulder muscle

The deltoid muscle is the muscle forming the rounded contour of the human shoulder. It is also known as the 'common shoulder muscle', particularly in other animals such as the domestic cat. Anatomically, the deltoid muscle appears to be made up of three distinct sets of muscle fibers, namely the

  1. anterior or clavicular part
  2. posterior or scapular part
  3. intermediate or acromial part
<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

<span class="mw-page-title-main">Rotator cuff tear</span> Shoulder injury

Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime.

Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

<span class="mw-page-title-main">Joint replacement</span> Orthopedic surgery to replace a joint

Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.

<span class="mw-page-title-main">Shoulder joint</span> Synovial ball and socket joint in the shoulder

The shoulder joint is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. It involves an articulation between the glenoid fossa of the scapula and the head of the humerus. Due to the very loose joint capsule that gives a limited interface of the humerus and scapula, it is the most mobile joint of the human body.

<span class="mw-page-title-main">SLAP tear</span> Medical condition

A SLAP tear or SLAP lesion is an injury to the superior glenoid labrum that initiates in the back of the labrum and stretches toward the front into the attachment point of the long head of the biceps tendon. SLAP is an acronym for "Superior Labrum Anterior and Posterior". SLAP lesions are commonly seen in overhead throwing athletes but middle-aged labor workers can also be affected, and they can be caused by chronic overuse or an acute stretch injury of the shoulder.

<span class="mw-page-title-main">Glenoid fossa</span> Part of the shoulder

The glenoid fossa of the scapula or the glenoid cavity is a bone part of the shoulder. The word glenoid is pronounced or and is from Greek: gléne, "socket", reflecting the shoulder joint's ball-and-socket form. It is a shallow, pyriform articular surface, which is located on the lateral angle of the scapula. It is directed laterally and forward and articulates with the head of the humerus; it is broader below than above and its vertical diameter is the longest.

<span class="mw-page-title-main">Dislocated shoulder</span> Injury

A dislocated shoulder is a condition in which the head of the humerus is detached from the glenoid fossa. Symptoms include shoulder pain and instability. Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve.

Shoulder arthritis can be one of three types of arthritis in the glenohumeral joint of the shoulder. The glenohumeral joint is a ball and socket joint, which relies on cartilage to move smoothly and to operate normally.

Shoulder surgery is a means of treating injured shoulders. Many surgeries have been developed to repair the muscles, connective tissue, or damaged joints that can arise from traumatic or overuse injuries to the shoulder.

<span class="mw-page-title-main">Shoulder replacement</span>

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

<span class="mw-page-title-main">Shoulder impingement syndrome</span> Medical condition

Shoulder impingement syndrome is a syndrome involving tendonitis of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle. This can result in pain, weakness, and loss of movement at the shoulder.

Evan Flatow is an American orthopaedic surgeon-scientist. As of 2023, he is President of Mount Sinai West, part of the Mount Sinai Health System. He published more than 400 book chapters and peer-reviewed articles. Flatow is indicated as principal or co-principal investigator for nine research grants and listed on six patents for influential shoulder implant systems.

The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The procedure was first described by French surgeon Dr. Michel Latarjet in 1954.

<span class="mw-page-title-main">Proximal humerus fracture</span> Break of the upper part of the bone of the arm

A proximal humerus fracture is a break of the upper part of the bone of the arm (humerus). Symptoms include pain, swelling, and a decreased ability to move the shoulder. Complications may include axillary nerve or axillary artery injury.

References

  1. 1 2 Walker M, Brooks J, Willis M, Frankle M (September 2011). "How reverse shoulder arthroplasty works". Clinical Orthopaedics and Related Research. 469 (9): 2440–51. doi:10.1007/s11999-011-1892-0. PMC   3148368 . PMID   21484471.
  2. 1 2 Pollock RG, Deliz ED, McIlveen SJ, Flatow EL, Bigliani LU (July 1992). "Prosthetic replacement in rotator cuff-deficient shoulders". Journal of Shoulder and Elbow Surgery. 1 (4): 173–86. doi:10.1016/1058-2746(92)90011-Q. PMID   22971621.
  3. ↑ Schairer WW, Nwachukwu BU, Lyman S, Craig EV, Gulotta LV (October 2015). "Reverse shoulder arthroplasty versus hemiarthroplasty for treatment of proximal humerus fractures". Journal of Shoulder and Elbow Surgery. 24 (10): 1560–6. doi:10.1016/j.jse.2015.03.018. PMID   25958208.
  4. ↑ Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM (2015). "Reverse Shoulder Arthroplasty in the United States: A Comparison of National Volume, Patient Demographics, Complications, and Surgical Indications". The Iowa Orthopaedic Journal. 35: 1–7. PMC   4492145 . PMID   26361437.
  5. 1 2 Flatow EL, Harrison AK (September 2011). "A history of reverse total shoulder arthroplasty". Clinical Orthopaedics and Related Research. 469 (9): 2432–9. doi:10.1007/s11999-010-1733-6. PMC   3148354 . PMID   21213090.
  6. ↑ Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA (April 2012). "The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty". Journal of Shoulder and Elbow Surgery. 21 (4): 514–22. doi:10.1016/j.jse.2011.03.006. PMID   21641825.
  7. ↑ Valsamis, Epaminondas Markos; Prats-Uribe, Albert; Koblbauer, Ian; Cole, Sophie; Sayers, Adrian; Whitehouse, Michael R; Coward, Gillian; Collins, Gary S.; Pinedo-Villanueva, Rafael; Prieto-Alhambra, Daniel; Rees, Jonathan L. (2023-06-21). "Reverse total shoulder replacement versus anatomical total shoulder replacement for osteoarthritis: population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England". BMJ. 385: e077939. doi:10.1136/bmj-2023-077939. ISSN   1756-1833. PMID   38688550.
  8. ↑ Werner BC, Wong AC, Mahony GT, Craig EV, Dines DM, Warren RF, Gulotta LV (March 2018). "Clinical Outcomes After Reverse Shoulder Arthroplasty With and Without Subscapularis Repair: The Importance of Considering Glenosphere Lateralization". The Journal of the American Academy of Orthopaedic Surgeons. 26 (5): e114–e119. doi:10.5435/JAAOS-D-16-00781. PMID   29419724. S2CID   3486951.
  9. ↑ Berhouet J, Garaud P, Favard L (December 2013). "Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study". Orthopaedics & Traumatology, Surgery & Research. 99 (8): 887–94. doi: 10.1016/j.otsr.2013.08.008 . PMID   24211248.
  10. 1 2 Gutiérrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA (December 2008). "Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors". The Journal of Bone and Joint Surgery. American Volume. 90 (12): 2606–15. doi:10.2106/JBJS.H.00012. PMID   19047705.
  11. 1 2 Keener JD, Patterson BM, Orvets N, Aleem AW, Chamberlain AM (February 2018). "Optimizing reverse shoulder arthroplasty component position in the setting of advanced arthritis with posterior glenoid erosion: a computer-enhanced range of motion analysis". Journal of Shoulder and Elbow Surgery. 27 (2): 339–349. doi:10.1016/j.jse.2017.09.011. PMID   29332666.
  12. 1 2 Werner BS, Chaoui J, Walch G (October 2017). "The influence of humeral neck shaft angle and glenoid lateralization on range of motion in reverse shoulder arthroplasty". Journal of Shoulder and Elbow Surgery. 26 (10): 1726–1731. doi:10.1016/j.jse.2017.03.032. PMID   28528016.
  13. ↑ Pupello D (2016). "Origins of Reverse Shoulder Arthroplasty and Common Misconceptions". Reverse Shoulder Arthroplasty. pp. 3–18. doi:10.1007/978-3-319-20840-4_1. ISBN   978-3-319-20839-8.
  14. ↑ Kessel L, Bayley I (October 1979). "Prosthetic replacement of shoulder joint: preliminary communication". Journal of the Royal Society of Medicine. 72 (10): 748–52. doi:10.1177/014107687907201010. PMC   1437172 . PMID   552433.
  15. ↑ Grammont PM, Baulot E (January 1993). "Delta shoulder prosthesis for rotator cuff rupture". Orthopedics. 16 (1): 65–8. doi:10.3928/0147-7447-19930101-11. PMID   8421661.
  16. ↑ Baulot E, Sirveaux F, Boileau P (September 2011). "Grammont's idea: The story of Paul Grammont's functional surgery concept and the development of the reverse principle". Clinical Orthopaedics and Related Research. 469 (9): 2425–31. doi:10.1007/s11999-010-1757-y. PMC   3148374 . PMID   21210311.
  17. ↑ USgranted 6790234,Frankle MA, Moad DC,"Reverse shoulder prosthesis system",published 4 January 2002,issued 14 September 2004, assigned to Encore Medical Asset Corp
  18. ↑ Pupello D, Frankle M (December 2011). "Regarding "Observations on retrieved humeral polyethylene components from reverse total shoulder arthroplasty"". Journal of Shoulder and Elbow Surgery. 20 (8): e22–3. doi: 10.1016/j.jse.2011.01.026 . PMID   21482152.
  19. ↑ Cuff DJ, Pupello DR, Santoni BG, Clark RE, Frankle MA (November 2017). "Reverse Shoulder Arthroplasty for the Treatment of Rotator Cuff Deficiency: A Concise Follow-up, at a Minimum of 10 Years, of Previous Reports". The Journal of Bone and Joint Surgery. American Volume. 99 (22): 1895–1899. doi:10.2106/JBJS.17.00175. PMID   29135662. S2CID   42436260.
  20. ↑ Gee, Edward C.A.; Hanson, Emma K.; Saithna, Adnan (2015-07-31). "Reverse Shoulder Arthroplasty in Rheumatoid Arthritis: A Systematic Review". The Open Orthopaedics Journal. 9 (1): 237–245. doi: 10.2174/1874325001509010237 . ISSN   1874-3250. PMC   4591906 . PMID   26448802.
  21. ↑ Middernacht B, Van Tongel A, De Wilde L (2016). "A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty". BioMed Research International. 2016: 1–9. doi: 10.1155/2016/3256931 . PMC   5220426 . PMID   28105417.
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