Reverse Shoulder Arthroplasty: Indications and Techniques
Purpose and Background
Glenohumeral arthritis includes osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis has been treated successfully with total shoulder arthroplasty for many years. 1 -3 In 1974, Dr. Neer3 reported the first series of patients who were successfully treated with anatomically designed total shoulder prosthesis. Despite the initial success, a small subset of patients did not have satisfactory outcomes with this prosthesis and had unacceptable failure rates. 3-5 These patients typically presented with a chronic and massive rotator cuff tear in addition to advance stage arthritis. This condition is called cuff tear arthropathy (CTA) which was described by Neer et a16 in 1983. The inciting event of CTA is a massive rotator cuff tear that alters the biomechanics of the shoulder leading to the development of degenerative arthritis. In addition, both nutritional and mechanical factors cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head in patients with CTA. Massive and chronic tear of the rotator cuff with retraction may result in severe atrophy and fatty infiltration of the cuff musculature preventing surgical repair.