Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

AbstractPurpose of ReviewOver the past decade, our understanding of the biomechanics of the reverse total shoulder arthroplasty (RTSA) has advanced, resulting in design adjustments, improved outcomes, and expanding indications. The purpose of this review is to summarize recent literature regarding the biomechanics of RTSA and the evolving indications for its use.Recent FindingsWhile Grammont ’s principles of RTSA biomechanics remain pillars of contemporary designs, a number of modifications have been proposed and trialed in later generations to address complications such as impingement and glenoid failure. Clinical and biomechanical literature suggest that less medialized, more inferi or glenospheres result in less impingement and notching. On the humerus, a more vertical neck cut is associated with less impingement. Indications for RTSA continue to expand beyond the classic indication of cuff tear arthropathy (CTA). Patients without a functional cuff but no arthritis now have a reliable option in the RTSA. RTSA has also replaced hemiarthroplasty as the implant of choice for displaced three- and four-part proximal humerus fractures in the elderly. Finally, updated design options and modular components now allow for treatment of glenoid bone loss, failed arthroplasty, and pr oximal humerus tumors with RTSA implants.SummaryReverse total shoulder arthroplasty design has been modernized on both the glenoid and humerus to address biomechanical challenges of early implants. As ou...
Source: Current Reviews in Musculoskeletal Medicine - Category: Orthopaedics Source Type: research