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Prosthesis design and placement in reverse total shoulder arthroplasty.

Ackland DC, Patel M, Knox D - J Orthop Surg Res (2015)

Bottom Line: The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging.Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability.Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function.

View Article: PubMed Central - PubMed

Affiliation: Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia. dackland@unimelb.edu.au.

ABSTRACT
The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62%. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome.

No MeSH data available.


Related in: MedlinePlus

Neer’s constrained reverse shoulder prosthesis concept (a) and the Delta III reverse shoulder prosthesis based on Grammont’s original design (b)
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Fig1: Neer’s constrained reverse shoulder prosthesis concept (a) and the Delta III reverse shoulder prosthesis based on Grammont’s original design (b)

Mentions: Reverse total shoulder arthroplasty (RSA) was first described by Grammont et al. in 1987, as a treatment for patients with cuff tear arthropathy for which non-operative treatment options had failed [1]. It involved reversing the polarity of ‘the ball and the socket’ by placing a ‘ball’ component at the glenoid and an articular ‘socket’ at the proximal humerus. Developed over two decades, the Delta III reverse prosthesis was introduced in 1991, and is a direct descendant of the initial Grammont prosthesis (Fig. 1) [2–4]. It has propagated a new family of reverse shoulder implants which are now available from numerous different manufacturers. With improvements in modern implant design and instrumentation, surgical techniques for RSA continue to evolve, as do the surgical indications [5, 6].Fig. 1


Prosthesis design and placement in reverse total shoulder arthroplasty.

Ackland DC, Patel M, Knox D - J Orthop Surg Res (2015)

Neer’s constrained reverse shoulder prosthesis concept (a) and the Delta III reverse shoulder prosthesis based on Grammont’s original design (b)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4493953&req=5

Fig1: Neer’s constrained reverse shoulder prosthesis concept (a) and the Delta III reverse shoulder prosthesis based on Grammont’s original design (b)
Mentions: Reverse total shoulder arthroplasty (RSA) was first described by Grammont et al. in 1987, as a treatment for patients with cuff tear arthropathy for which non-operative treatment options had failed [1]. It involved reversing the polarity of ‘the ball and the socket’ by placing a ‘ball’ component at the glenoid and an articular ‘socket’ at the proximal humerus. Developed over two decades, the Delta III reverse prosthesis was introduced in 1991, and is a direct descendant of the initial Grammont prosthesis (Fig. 1) [2–4]. It has propagated a new family of reverse shoulder implants which are now available from numerous different manufacturers. With improvements in modern implant design and instrumentation, surgical techniques for RSA continue to evolve, as do the surgical indications [5, 6].Fig. 1

Bottom Line: The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging.Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability.Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function.

View Article: PubMed Central - PubMed

Affiliation: Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia. dackland@unimelb.edu.au.

ABSTRACT
The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62%. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome.

No MeSH data available.


Related in: MedlinePlus