Reverse Shoulder Arthroplasty in the Management of Irreparable Rotator Cuff Tears without Arthritis.

INTRODUCTION

The ability to provide reliable outcomes in treatment of patients with degenerative rotator cuff tears has become increasingly complicated, as a result of more advanced disease and the increased array of treatment choices.

STEP 1 PREOPERATIVE PLANNING: Develop and communicate with a consistent team of interdisciplinary physicians both preoperatively and postoperatively; utilize advanced imaging modalities to evaluate muscle atrophy as well as glenoid and humeral bone stock.

STEP 2 PATIENT POSITIONING: Place the patient in a beach-chair position, check the abdominal strap, and position yourself facing the axilla.

STEP 3 SURGICAL APPROACH: Develop the subdeltoid and subacromial spaces and take care to avoid vigorous over-retraction of the deltoid.

STEP 4 HUMERAL EXPOSURE AND PREPARATION: Perform the head cut utilizing the 135° resection guide, broach the humerus, and ream the humeral socket.

STEP 5 GLENOID EXPOSURE AND PREPARATION GLENOSPHERE INSERTION: Ream the inferior surface to bleeding subchondral bone; bleeding subchondral bone on the inferior 50% of the prepared glenoid surface indicates a sufficient depth.

STEP 6 FINAL HUMERAL PREPARATION: At final reaming, the edge of the reamer should sit flush with the cut surface of the humerus.

STEP 7 TRIALING: Proper soft-tissue balance is frequently achieved by positioning the humeral component so that the rim of the socket lies just above the humeral osteotomy site at the anatomic neck.

STEP 8 COMPONENT IMPLANTATION AND CLOSURE: When cementing the humeral component, the socket should match the reamed proximal part of the humerus.

RESULTS

Initially, reverse shoulder arthroplasty was primarily used to treat osteoarthritis of the glenohumeral joint resulting from chronic rotator cuff deficiency or for true rotator cuff tear arthropathy.

WHAT TO WATCH FOR

Indications Contraindications Pitfalls & Challenges.