Summary The AltiVate Reverse Shoulder System by Enovis is a reverse shoulder arthroplasty platform designed to restore mobility in patients with rotator cuff deficiency by optimizing implant fit and fixation. It uses a lateralized center of rotation and a 135° humeral neck-shaft angle to improve range of motion and reduce complications like scapular notching. The system incorporates modular components and precision instrumentation to better match patient anatomy and support stable long-term fixation. Indications Indications reverse total shoulder for patients with a functional deltoid muscle and a grossly deficient rotator cuff joint pain and dysfunction due to severe arthropathy with a grossly deficient rotator cuff previously failed joint replacement with a grossly deficient rotator cuff fracture of the glenohumeral joint from trauma or pathologic conditions including humeral head fracture, displaced 3- or 4-part fractures of the proximal humerus, or reconstruction after tumor resection bone defect in the proximal humerus anatomic total shoulder pain and dysfunction due to noninflammatory degenerative joint disease including osteoarthritis inflammatory arthritis of the glenohumeral joint including rheumatoid arthritis post-traumatic arthritis of the glenohumeral joint avascular necrosis of the humeral head with and without involvement of the glenoid the all-poly glenoid is intended for cemented use hemi shoulder pain and dysfunction due to noninflammatory degenerative joint disease including osteoarthritis inflammatory arthritis of the glenohumeral joint including rheumatoid arthritis post-traumatic arthritis of the glenohumeral joint avascular necrosis of the humeral head with and without involvement of the glenoid rotator cuff tear arthropathy Contraindications infection or sepsis insufficient bone quality which may affect the stability of the implant materials sensitivity non-functional deltoid muscle intraoperative conversion from a reverse to an anatomic shoulder Anatomy Osteology acromioclavicular joint is used as an incision landmark anatomic neck of the humerus is the stated osteotomy height and visualization target Muscles deltoid must be functional for reverse total shoulder indication is freed from the cephalic vein during the deltopectoral approach lateral undersurface is used as a distal axillary nerve palpation site is relaxed during glenoid exposure by arm positioning subscapularis lower subscapularis is a proximal axillary nerve palpation landmark remnant tendon is released from the lesser tuberosity and proximal humerus is retracted during glenoid exposure supraspinatus the humeral canal entry point is described at the greater tuberosity where the supraspinatus tendon normally would attach pectoralis major a portion of the tendon insertion is released during the approach long head of the biceps tendon should not be damaged during the approach is exposed and the rotator interval is opened to the superior rim of the glenoid conjoined tendon is identified during exposure Ligaments coracohumeral ligament is released from the lateral coracoid during glenoid exposure glenohumeral ligaments are released and excised from the glenoid during exposure capsule is released and excised from the glenoid, and the inferior capsule is excised for visualization labrum is released and excised from the glenoid Nerves interscalene nerve block is described as preferable before positioning musculocutaneous nerve traction injury is a specific risk if medial retractors are used on the conjoined tendon axillary nerve is palpated proximally between the conjoined tendon and the lower subscapularis muscle is palpated distally on the undersurface of the lateral deltoid muscle is confirmed with the tug test is at risk near posterior-inferior capsular resection is re-examined with the tug test after final reduction brachial plexus traction injuries are specifically noted as a risk during anterior retraction around the glenoid Blood supply cephalic vein is identified and preserved during the deltopectoral approach anterior humeral circumflex vessels are ligated at the lower portion of the subscapularis Approach Patient preparation and positioning general endotracheal anesthesia combined with an interscalene nerve block is described as preferable prior to positioning the patient is placed in an upright beach chair position with the head firmly secured and the arm draped free the operative arm must be sufficiently off to the side of the bed to allow unobstructed movement in adduction and hyperextension Exposure an extended deltopectoral approach is used the subdeltoid, subacromial, and subcoracoid spaces are exposed, the subacromial bursa is excised, the coracoid tip and conjoined tendon are identified, and the clavipectoral fascia is incised on the lateral border of the conjoined tendon Technical specifications Humeral stems Shell type Short length 48mm Standard length 108mm Revision length 175mm and 220mm Standard shell (diameter) 6mm, 8mm, 10mm, 12mm, 14mm, 16mm, and 18mm 6mm, 8mm, 10mm, 12mm, 14mm, 16mm, and 18mm 175mm: 6mm, 8mm, 10mm, 12mm, 14mm, and 16mm 220mm: 6mm, 8mm, and 10mm Small shell (diameter) 6mm, 8mm, 10mm, and 12mm 6mm, 8mm, 10mm, and 12mm 175mm: 6mm, 8mm, 10mm, and 12mm 220mm: 6mm, 8mm, and 10mm Reverse glenoid construct 5.0 mm locking peripheral screws are listed in lengths of 14, 18, 22, 26, 30, 34, and 38 mm 3.5 mm nonlocking peripheral screws are listed in lengths of 14 to 38 mm in 2 mm increments Reverse glenoid heads and socket inserts 32, 36, 40, and 44 mm reverse glenoid head options all glenoid heads are described as having a 5.4 mm central hole for a 16 mm retaining screw socket inserts are listed for standard shell and small shell constructs in 32, 36, 40, and 44 mm diameters insert thickness options are standard and +4 constraint options are standard and semi-constrained standard poly and E+ poly inserts are listed Spacers, instruments, and preparation sizes spacer options are standard +8 mm, small shell +8 mm, and small shell +12 mm humeral canal reamers are listed from 6 mm to 20 mm in 2 mm increments, with a 5 mm starter reamer standard and short humeral broaches are listed in 6, 8, 10, 12, 14, 16, 18, and 20 mm sizes socket shell reamers are listed as small press-fit, small cemented, standard press-fit, and standard cemented humeral planers and humeral protectors are available in small and large sizes Anatomic and hemi compatibility hemi-adaptors are listed in standard and small shell versions tandard and offset configurations from 38x14 through 56x22, depending on configuration