Reverse Shoulder Arthroplasty for the Massive Rotator Cuff Tear
At ICJR’s Pan Pacific Orthopaedic Congress, Dr. John Sperling said that greater success with the reverse shoulder prosthesis has translated to greater interest in expanding its indications. Below is the abstract of his presentation.
By John W. Sperling, MD, MBA
Orthopaedic surgeons have become increasingly interested in the use of reverse total shoulder arthroplasty to manage massive rotator cuff tears. This has been due to the success we have had with the procedure as the rate of complications decreased, thanks to the significant knowledge we have gained over the course of the past 10 years of using the reverse prosthesis.
Preoperative planning is critical to ensuring proper component placement. At minimum, high-quality anterior-posterior and axillary radiographs are necessary. In my practice, I obtain a thin-cut CT scan on all patients. This allows me to understand the version of the glenoid, the specific wear pattern, and the amount of wear.
A growing area of interest is the use of patient-specific instrumentation. This tool may help facilitate accurate component placement, as well as decrease the number of outliers.
There continues to be debate about the proper intraoperative humeral version. Initially, the humeral component was placed in neutral version. Now, a number of surgeons place the humeral component in 20° to 30° of retroversion. In this position, the humerus faces across from the glenoid with the arm in the neutral position.
There has also been a strong trend toward the use of uncemented humeral components and shorter stems. This may facilitate flexibility at the time of surgery, as well as facilitate future revision surgery if necessary.
Initially, there was concern that there would be a high rate of glenoid loosening with the reverse. However, the rate of glenoid baseplate loosening has been shown to be low. Placing the glenoid baseplate with 10° of inferior tilt has been shown to significantly decrease the rate of loosening.
In addition, eccentric glenospheres have decreased the overall rate of notching ,which was reported to be high in the initial series in the literature.
The indications for the reverse arthroplasty continue to broaden. Mid-term studies show encouraging results in the treatment of a spectrum of shoulder disorders, including the massive rotator cuff tear, with reverse total shoulder arthroplasty.
John W. Sperling, MD, MBA, is from Mayo Clinic, Rochester, Minnesota.