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Reverse Total Shoulder Arthroplasty

Philip Kasten, MD, PhD, and Jörg Lützner, MD

The reverse shoulder prosthesis is based on a concept introduced by Paul Grammont. It relies on the principles of a semiconstrained ball and socket configuration, medialization of the center of rotation, and tensioning of the deltoid muscle. This can allow flexion of the arm in, for example, rotator cuff tear arthropathies and revision situations. External rotation depends on intact external rotators (the infraspinatus and teres minor). Current data support the use of reverse total shoulder arthroplasty (RTSA), which has good short- and mid-term outcomes and allows the management of conditions that were previously beyond surgical treatment. However, significantly higher revision and complication rates compared with conventional TSA and functional deterioration after 5–10 years have been reported with RTSA. Although current changes in the design of reverse shoulder prostheses might reduce the complication rate in the future, currently this technique should be reserved for elderly patients and salvage situations. Adv Orthop 2010;2(1):1–7.

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