Introduction Use of a convex glenoid (hemispheric ball) and concave humerus (articulating cup) to reconstruct the glenohumeral joint center of rotation (COR) is moved inferiorly and medialized allows the deltoid muscle to act on a longer fulcrum and have more mechanical advantage therefore, deltoid must be functional History popularized in Europe and now increasingly used in North America Indications Indications clinical conditions CTA pseudoparalysis an inability to actively elevate the arm in the presence of free passive ROM and in the absence of a neurologic lesion occurs secondary to irreparable rotator cuff tear in setting of glenohumeral arthritis antero-superior escape incompetent coracoacromial arch humeral "escape" in subcutaneous tissue with hemiarthroplasty acute 3 or 4-part proximal humerus fractures in the elderly where GT has poor potential for healing and bone quality is poor for primary repair rotator cuff insufficiency 'equivalent' non-union or mal-union of the tuberosity following trauma or prior arthroplasty failed arthroplasty when all other options have been exhausted rheumatoid arthritis only if glenoid bone stock is sufficient patient characteristics (in clinical conditions above) low functional demand patients physiological age >70 sufficient glenoid bone stock working deltoid muscle intact axillary nerve Contraindications deltoid deficiency (axillary nerve palsy) bony acromion deficiency glenoid osteoporosis active infection Biomechanics Biomechanics the advantage of a reverse shoulder arthroplasty is that the center of rotation (COR) is moved inferiorly and medialized allows the deltoid muscle to act on a longer fulcrum and have more mechanical advantage to substitute for the deficient rotator cuff muscles to provide shoulder abduction allows increased (but not normal) shoulder abduction does not significantly help shoulder internal or external rotation reverse shoulder arthroplasty can be combined with latissimus dorsi transfer to assist with external rotation Surgical Technique Approaches superolateral lower incidence of postoperative instability lower risk of intraoperative scapular spine and acromion fractures deltopectoral better preservation of active external rotation better orientation of glenoid component decreased risk of glenoid loosening and scapular notching often used for revision surgery Technique humeral preparation humeral head typically osteotomized anywhere between 0 and 30 degrees of retroversion more retroversion is gaining popularity as it may improve post-op external rotation long head of biceps is tenotomized ream and broach humerus similar to conventional TSA glenoid preparation labrum is excised and capsule is released circumferentially accurate central guidewire placement is dictated by availability of the best bone stock for baseplate screw fixation place baseplate as inferiorly as possible with an inferior tilt shown to decrease implant loosening and scapular notching mount glenosphere onto baseplate tuberosity repair anatomic repair of the greater tuberosity is associated with improved shoulder external rotation, function and patient satisfaction compared to tuberosity resection or malunion Postoperative Care patient placed in sling post-op may allow use of arm for light ADLs (brushing teeth and eating) sling discontinued at 3 weeks if subscapularis is NOT repaired, and 6 weeks if subscapularis is repaired Outcomes There are no high quality long-term outcome studies present in literature Results are dependent on indication, with cuff tear arthropathy (CTA) having the best results Some cases series' have noted 10 year survivability is approximately 90% for implant retention Radiographic results deteriorate after 6 years and clinical results after 8 years Complications Scapular notching common related to impingement by the medial rim of the humeral cup during adduction increased risk with superiorly placed glenoid component, or insufficient inferior tilt of glenoid component on the native glenoid Dislocation reported rate between 2% - 3.4% usually anterior instability increased risk with irreparable subscapularis (strongest risk) proximal humeral bone loss failed prior arthroplasty proximal humeral nonunion fixed glenohumeral dislocation preop NOT related to condition of rotator cuff Glenoid Loosening glenoid prosthetic loosening is most common mechanism of failure treat using staged procedure to fill glenoid cavity with autogenous bone and await incorporation with a hemiarthroplasty prior to reimplantation of a new glenosphere Deep Infection susceptible to infection due to large subacromial dead space created by reverse prosthesis most common organisms include propionibacterium acnes and staphylococci Acromion and Scapular Spine Fractures Neurapraxia Sirveaux Classification of Scapular Notching Grade 1 limited to scapular pillar Grade 2 in contact with inferior screw of baseplate Grade 3 beyond the inferior screw Grade 4 extends under baseplate approaching central peg
Technique Guide CPT Codes: 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Reverse Total Shoulder Arthroplasty Orthobullets Team Shoulder & Elbow - Rotator Cuff Arthropathy
QUESTIONS 1 of 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE13BS.52) Reverse total shoulder arthroplasty improves kinematics in the rotator cuff deficient joint by what directional change to the center of rotation? Review Topic QID: 8289 Type & Select Correct Answer 1 Medial 76% (156/205) 2 Lateral 22% (45/205) 3 Posterior 0% (1/205) 4 Proximal 1% (2/205) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.102) A 75-year-old male with 2 previous rotator cuff repairs has persistent shoulder pain and active forward elevation to 60 degrees. He has normal deltoid function with a positive lift-off test. Radiographs and coronal MRI of his shoulder are found in Figures A through C. Which of the following treatment options is most appropriate? Review Topic QID: 3525 FIGURES: A B C D Type & Select Correct Answer 1 Revision supraspinatus repair 1% (13/1855) 2 Shoulder hemiarthroplasty 2% (43/1855) 3 Total shoulder arthroplasty 3% (50/1855) 4 Reverse total shoulder arthroplasty 92% (1705/1855) 5 Latissimus transfer 2% (39/1855) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.231) An 79-year-old male presents with longstanding left shoulder pain and difficulty with raising his arm over his head. His exam shows wasting of the deltoid and obvious scapular dysrhythmia on the left side. He lacks the ability to do any forward flexion or external rotation in his left shoulder. He can internally rotate without difficulty. His radiograph and MRI images are seen in figures A and B respectively. He wants to know if he is a candidate for a reverse shoulder arthroplasty (RSA). Which of the following answer choices is the MOST appropriate response? Review Topic QID: 3654 FIGURES: A B Type & Select Correct Answer 1 He is a candidate for RSA due to rotator cuff tear arthropathy 11% (286/2681) 2 He is a candidate for RSA due to ability to internally rotate 1% (20/2681) 3 He is not a candidate for RSA due to deltoid dysfunction 87% (2322/2681) 4 He is not a candidate for RSA due to massive rotator cuff tear 1% (37/2681) 5 He is not a candidate for RSA due to his age 0% (3/2681) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.87) Superior placement of the baseplate during reverse shoulder arthroplasty is a known technical risk factor for which of the following complications? Review Topic QID: 3510 Type & Select Correct Answer 1 Inferior acromial erosion 7% (293/4222) 2 Humeral component loosening 2% (85/4222) 3 Infection 0% (11/4222) 4 Inferior scapular notching 82% (3469/4222) 5 Superior scapular notching 8% (347/4222) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 4 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ10.274) Deltoid denervation is a contraindication to which of the following procedures? Review Topic QID: 3362 Type & Select Correct Answer 1 C5-6 anterior cervical diskectomy and fusion 1% (12/2166) 2 Reverse total shoulder arthroplasty 98% (2116/2166) 3 Shoulder arthrodesis 0% (9/2166) 4 Biceps tenodesis 0% (9/2166) 5 Arthroscopic subacromial decompression 1% (13/2166) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ09.9) What technical error leads to scapular notching after reverse total shoulder arthroplasty? Review Topic QID: 2822 Type & Select Correct Answer 1 Superior placement of the glenoid component 69% (372/541) 2 Retroverted placement of the glenoid component 9% (47/541) 3 Inferior placement of the glenoid component 14% (77/541) 4 Overtensioning of the soft tissue envelope 1% (5/541) 5 Inferior tilt of the glenoid component 6% (33/541) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ08.199) A 76-year-old man has a two-year history of shoulder pain which no longer responds to non-operative treatments. A radiograph is shown in Figure A. He has forward flexion to 80 degrees and abduction to 70 degrees. An example of his belly push examination is shown in Figure B. What is the most appropriate surgical procedure? Review Topic QID: 585 FIGURES: A B Type & Select Correct Answer 1 Arthroscopic debridement and subacromial decompression 4% (33/894) 2 Open rotator cuff repair 1% (8/894) 3 Total shoulder arthroplasty 15% (133/894) 4 Reverse shoulder arthroplasty 80% (713/894) 5 Shoulder arthrodesis 0% (2/894) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ08.231) Which of the following patients would be the most appropriate candidate for a reverse total shoulder replacement? Review Topic QID: 617 Type & Select Correct Answer 1 A 71-year-old man with a massive rotator cuff tear, glenohumeral arthritis, and forward elevation to 40 degrees 81% (562/692) 2 A 45-year-old man who has failed 3 rotator cuff repairs and has glenohumeral arthritis 8% (57/692) 3 A 65-year-old man with glenoid wear and pain 10 years following a hemiarthroplasty 4% (28/692) 4 A 72-year-old man with severe glenohumeral arthritis and an intact rotator cuff 6% (40/692) 5 A 30-year-old man with a locked posterior shoulder dislocation 0% (1/692) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 1 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ08.73) Early reverse total shoulder designs (before the development of the Grammont-style prosthesis) had a high failure rate due to early loosening of the glenoid component. What biomechanical feature accounted for this problem? Review Topic QID: 459 Type & Select Correct Answer 1 Glenoid component did not have a neck 8% (41/535) 2 Humeral component too horizontal 4% (24/535) 3 Center of rotation too lateral 63% (335/535) 4 Center of rotation too anterior 7% (36/535) 5 Center of rotation too inferior 18% (94/535) L 3 Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.31) Which of the following patient scenarios is most appropriate for reverse total shoulder arthroplasty? Review Topic QID: 142 Type & Select Correct Answer 1 A 40-year-old laborer severe glenohumeral arthritis and irrepairable rotator cuff tear. 3% (44/1365) 2 A 40-year-old with a painful proximal humerus malunion. 0% (6/1365) 3 A 75-year-old woman with severe arthritis and active overhead motion. 2% (34/1365) 4 A 75-year-old man with painful arthritis and a massive irrepairable rotator cuff tear 93% (1266/1365) 5 Failed hemiarthroplasty due to significant glenoid wear. 1% (13/1365) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 4
All Videos (34) Podcasts (3) 2018 Orthopaedic Summit Evolving Techniques Reverse TSA For Complex Proximal Humeral Fractures - Sumant "Butch" Kirshnan, MD (OSET 2018) Shoulder & Elbow - Reverse Shoulder Arthroplasty 4 weeks ago 188 views Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Video Spotlight: Reverse Total Shoulder Arthroplasty for Irreparable Rotator Cuff - Evan Lederman, MD (1.33, 2018 Winter SKS) Evan Lederman Shoulder & Elbow - Reverse Shoulder Arthroplasty 7/11/2018 422 views Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine When is Reverse Total Shoulder Arthroplasty the Only Option? - Anthony Romeo, MD (1.32, 2018 Winter SKS) Anthony Romeo Shoulder & Elbow - Reverse Shoulder Arthroplasty 7/11/2018 318 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Brad Parsons, MD - Spotlight Session non-CME Brad Parsons Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 129 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Case Presentations with Questions and Answers Moderator: - Lawrence V. Gulotta, MD Lawrence Gulotta Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 99 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques How Young is Too Young for the Reverse? - Quin Throckmorton, MD Thomas Throckmorton Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 140 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Who Does Not Do Well Following RSA: Who to Stay Away From - Lawrence V. Gulotta, MD Lawrence Gulotta Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 131 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Outcomes Following RSA: What are Our Patients Doing and Should They Be Doing Them? - Patrick St. Pierre, MD Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 109 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Evolving Technique Update: How I Do A Perfect RSA Every Time - Richard J. Friedman, MD, FRCSC Richard Friedman Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 168 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques The Reverse Shoulder Arthroplasty: Back to Basics - George S. Athwal, MD, FRCSC Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 1133 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Pro: Rotator Cuff Tears: Subscap and Posterosuperior - Crapped Out? - John W. Sperling, MD, MBA John Sperling Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 121 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Pro: RSA is the Only Answer! Sneak Preview to Future Lectures - Patrick St. Pierre, MD Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/2/2018 105 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2017 Whats New In Sports & Shoulder: Rapid Fire Q&A (COA 2017, 9.5) Tal David Shoulder & Elbow - Reverse Shoulder Arthroplasty 4/13/2018 176 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2017 Reverse Total Shoulder Arthroplasty – Matthew Meunier, M.D. (COA 2017,9.3) Matthew Meunier Shoulder & Elbow - Reverse Shoulder Arthroplasty 4/13/2018 351 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Reverse Shoulder Arthroplasty: Management of Glenoid Bone Loss - Gregory P. Nicholson, MD (CSMS #74, 2017) Gregory Nicholson Shoulder & Elbow - Reverse Shoulder Arthroplasty 11/16/2017 257 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Rehabilitation Following Total and Reverse Shoulder Arthroplasty - Michael Reinold, DPT, SCS (CSMS #55, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 11/16/2017 83 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Reverse Arthroplasty: When do I pull the trigger? - Gregory P. Nicholson, MD (CSMS #40, 2017) Gregory Nicholson Shoulder & Elbow - Reverse Shoulder Arthroplasty 11/16/2017 73 views Login to View Community Videos Login to View Community Videos 29th Orthopaedic Trauma - What We Need to Know in 2017 Panel Discussion - Upper Extremity II (NYT #19 - S3-8 - 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 10/3/2017 139 views Login to View Community Videos Login to View Community Videos 29th Orthopaedic Trauma - What We Need to Know in 2017 Reverse Total Shoulder - When and How? William N. Levine, MD - (NYT #15 - S3-1 - 2017) William Levine Shoulder & Elbow - Reverse Shoulder Arthroplasty 10/3/2017 361 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery Instability Bankart Remplssage- Basics: Jeffrey Abrams, MD (CSSE #2, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/11/2017 696 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery Humeral Bone Loss in Reverse TSA: Dean Harter, MD (CSSE #41, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 170 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery The Unstable Reverse Shoulder Arthroplasty - What Now?: Richard Friedman, MD (CSSE #40, 2017) Richard Friedman Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 179 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery Revision to Reverse with Glenoid Bone Loss: Edwin Spencer, MD (CSSE #39, 2017) Edwin Spencer Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 117 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery Primary Reverse Shoulder Arthroplasty with Glenoid Bone Loss: Andrew Green, MD (CSSE #38, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 154 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery My Experience Using Reverse Shoulder Replacement: Buzz Burkhead, MD (CSSE #34, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 128 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery Repair Options - Massive Cuff Tear - I Can Fix It: Jeff Abrams, MD (CSSE #33, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 183 views Upgrade to View Premium Videos Upgrade to View Premium Videos 2017 Current Solutions in Shoulder and Elbow Surgery Reverse Design Rationale: Mark Frankle, MD (CSSE #28, 2017) Mark Frankle Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 213 views Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Shoulder and Elbow Surgery Reverse for Fracture: T. Bradley Edwards, MD (CSSE #23, 2017) Shoulder & Elbow - Reverse Shoulder Arthroplasty 5/10/2017 168 views Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Reverse or Repair: How do I decide? - Gregory P. Nicholson, MD (CSMS #33, 2016) Gregory Nicholson Shoulder & Elbow - Reverse Shoulder Arthroplasty 10/25/2016 147 views Upgrade to View Premium Videos Upgrade to View Premium Videos Reverse Total Shoulder Arthroplasty - Dr. Anthony Romeo Shoulder & Elbow - Reverse Shoulder Arthroplasty 7/30/2016 784 views Upgrade to View Premium Videos Upgrade to View Premium Videos Video - Latissimus Dorsi/Teres Major Transfer for External Rotation in RSA - Dr. Tom Norris - Part 2 Shoulder & Elbow - Reverse Shoulder Arthroplasty 12/8/2012 272 views Upgrade to View Premium Videos Upgrade to View Premium Videos Latissimus Dorsi/Teres Major Transfer for External Rotation in RSA - Dr. Tom Norris - Part I Shoulder & Elbow - Reverse Shoulder Arthroplasty 12/8/2012 272 views Upgrade to View Premium Videos Upgrade to View Premium Videos Reversed Total Shoulder Replacement - Dr. Jim Kelly Shoulder & Elbow - Reverse Shoulder Arthroplasty 10/2/2012 1035 views Upgrade to View Premium Videos Upgrade to View Premium Videos Reverse Shoulder Arthroplasty for 4-Part Fracture - Mark Frankle, M.D. Shoulder & Elbow - Reverse Shoulder Arthroplasty 7/17/2012 258 views Shoulder & Elbow⎪Reverse Shoulder Arthroplasty Team Orthobullets 4 Shoulder & Elbow - Reverse Shoulder Arthroplasty Listen Now 8:58 min 4 weeks ago 12 plays Shoulder & Elbow ⎜ Reverse Total Shoulder Arthroplasty Team Orthobullets (AF) Shoulder & Elbow - Reverse Shoulder Arthroplasty Listen Now 9:48 min 4 weeks ago 3 plays Question Session⎪Reverse Shoulder Arthroplasty & THA Revision Orthobullets Team Shoulder & Elbow - Reverse Shoulder Arthroplasty Listen Now 26:27 min 1 week ago 2 plays See More See Less
P acnes infected shoulder after ORIF and cuff repair (C1410) Shoulder & Elbow - Reverse Shoulder Arthroplasty 2/12/2013 114 1 5