Primary shoulder reverse arthroplasty: surgical technique.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Musculoskeletal Research

Background:

• Total reverse shoulder replacement (TRSR) is a common procedure for rotator cuff tear arthropathies and massive rotator cuff tears.
• While effective, implant survival in older series decreases between 8-10 years, influencing patient selection (typically >70 years old).
• Technical modifications are continuously explored to enhance surgical technique, fixation, and mechanical performance of the prosthesis.

Purpose of the Study:

• To assess and describe critical preoperative criteria for TRSR.
• To detail essential surgical conditions and technical aspects for successful TRSR.
• To evaluate options for glenoid component positioning and adjunctive muscle transfers.

Main Methods:

• Review of current literature and surgical techniques for total reverse shoulder replacement.
• Analysis of factors influencing implant survival and clinical outcomes.
• Discussion of evolving surgical options, including glenoid component placement and muscle transfers.

Main Results:

• Identified key preoperative factors and surgical conditions essential for TRSR.
• Highlighted technical modifications aimed at improving fixation and mechanical function.
• Explored glenoid component positioning strategies (lateralization, bone grafting, orientation) and muscle transfer associations.

Conclusions:

• TRSR is a viable option for specific indications like massive rotator cuff tears with or without osteoarthritis, primary osteoarthritis with rotator cuff involvement, and rheumatoid arthritis.
• Optimizing preoperative assessment and surgical technique, including glenoid component management, is vital for enhancing clinical outcomes and implant longevity.
• Further evaluation of technical modifications and adjunctive procedures like muscle transfers may improve long-term results.