Indications for reverse total shoulder arthroplasty in rotator cuff disease

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Reverse total shoulder arthroplasty (RTSA) was initially for rotator cuff tear arthropathy but its use has broadened.
• The appropriateness of RTSA for various rotator cuff diseases remains under investigation despite increased utilization since 2004.

Purpose of the Study:

• To review RTSA use in rotator cuff disease.
• Classify rotator cuff tear reparability and shoulder balance.
• Explore RTSA design theory, indications, contraindications, and outcomes.

Main Methods:

• A selective literature review was conducted.
• The study is a Level V therapeutic study.

Main Results:

• Modern RTSA designs re-establish deltoid tension and a functional fulcrum in shoulders with rotator cuff deficiency.
• This leads to recovery of active shoulder elevation and functional restoration in the short to medium term.

Conclusions:

• RTSA alleviates symptoms and restores function in patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis.
• Contraindications include severely impaired deltoid function, isolated supraspinatus tears, and arthritis with preserved active elevation in massive tears.
• For carefully selected patients with disabling rotator cuff deficiency, RTSA offers significant improvements in pain, motion, function, and satisfaction.