Total reverse shoulder arthroplasty: European lessons and future trends

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Grammont introduced a novel reverse total shoulder arthroplasty (TSA) in the late 1980s.
• This design aimed to improve upon previous shoulder replacement limitations.
• It features a hemisphere attached to the glenoid and medialized center of rotation.

Purpose of the Study:

• To evaluate the clinical outcomes of the Grammont reverse total shoulder arthroplasty.
• To assess functional results, pain relief, range of motion, and complication rates.
• To investigate the incidence and clinical significance of inferior glenoid notching.

Main Methods:

• Review of mid- and long-term clinical studies on the Grammont reverse TSA.
• Analysis of functional outcomes (e.g., Constant-Score), range of motion, and complication data.
• Assessment of glenoid erosion (inferior glenoid notching) rates and potential clinical impact.

Main Results:

• Good functional outcomes (Constant-Score 60-69) and pain relief were observed, even in complex cases.
• Limited passive internal rotation and no improvement in active external rotation were noted.
• Inferior glenoid notching occurred frequently (10-42%), with controversial clinical impact.
• Higher complication rates compared to conventional TSA were reported.

Conclusions:

• The Grammont reverse TSA offers significant benefits in pain relief and function for challenging shoulder conditions.
• Limitations include restricted rotation and a high incidence of inferior glenoid notching.
• Further improvements in prosthesis design and surgical technique are needed to mitigate complications and notching.