Reverse Shoulder Arthroplasty in the Management of Irreparable Rotator Cuff Tears without Arthritis.

INTRODUCTION: The ability to provide reliable outcomes in treatment of patients with degenerative rotator cuff tears has become increasingly complicated, as a result of more advanced disease and the increased array of treatment choices. STEP 1 PREOPERATIVE PLANNING: Develop and communicate with a consistent team of interdisciplinary physicians both preoperatively and postoperatively; utilize advanced imaging modalities to evaluate muscle atrophy as well as glenoid and humeral bone stock. STEP 2 PATIENT POSITIONING: Place the patient in a beach-chair position, check the abdominal strap, and position yourself facing the axilla. STEP 3 SURGICAL APPROACH: Develop the subdeltoid and subacromial spaces and take care to avoid vigorous over-retraction of the deltoid. STEP 4 HUMERAL EXPOSURE AND PREPARATION: Perform the head cut utilizing the 135° resection guide, broach the humerus, and ream the humeral socket. STEP 5 GLENOID EXPOSURE AND PREPARATION GLENOSPHERE INSERTION: Ream the inferior surface to bleeding subchondral bone; bleeding subchondral bone on the inferior 50% of the prepared glenoid surface indicates a sufficient depth. STEP 6 FINAL HUMERAL PREPARATION: At final reaming, the edge of the reamer should sit flush with the cut surface of the humerus. STEP 7 TRIALING: Proper soft-tissue balance is frequently achieved by positioning the humeral component so that the rim of the socket lies just above the humeral osteotomy site at the anatomic neck. STEP 8 COMPONENT IMPLANTATION AND CLOSURE: When cementing the humeral component, the socket should match the reamed proximal part of the humerus.
RESULTS: Initially, reverse shoulder arthroplasty was primarily used to treat osteoarthritis of the glenohumeral joint resulting from chronic rotator cuff deficiency or for true rotator cuff tear arthropathy. WHAT TO WATCH FOR: Indications Contraindications Pitfalls & Challenges.