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Reverse Shoulder Arthroplasty

Surgical reconstruction reversing native ball-and-socket anatomy with glenoid-side hemisphere and humeral-side socket, designed by Grammont (1985), for cuff tear arthropathy, irreparable rotator cuff tears, fracture sequelae, and revision shoulder arthroplasty.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Reverse Shoulder Arthroplasty?

Reverse total shoulder arthroplasty (rTSA) is a surgical procedure that reverses the natural anatomical ball-and-socket configuration of the glenohumeral joint. The convex glenosphere is placed on the glenoid and concave humeral cup on the proximal humerus. Designed by French surgeon Paul Grammont in 1985, this revolutionary concept addresses shoulder dysfunction in cuff-deficient shoulders by lowering and medializing the center of rotation, allowing the deltoid muscle to substitute for the absent or insufficient rotator cuff.

Indications include cuff tear arthropathy (Hamada classification grade 3-5), massive irreparable rotator cuff tears with pseudoparalysis, displaced 3/4-part proximal humerus fractures in elderly patients (improving outcomes vs hemiarthroplasty), severe sequelae of proximal humerus fractures with malunion or avascular necrosis, revision of failed anatomic total shoulder arthroplasty (TSA), inflammatory arthritis with cuff insufficiency, and bone loss requiring augmentation.

Modern implant designs include lateralized glenosphere reducing scapular notching, augmented baseplates for glenoid bone loss, modular humeral components allowing version adjustment, and various neck-shaft angles (135°, 145°, 155°) optimizing biomechanics. Contemporary outcomes show 90%+ implant survivorship at 10 years, significant pain relief, and functional improvement (forward elevation typically 120-140°). Complications include scapular notching (radiographic, often clinically insignificant), instability, infection, and acromial stress fractures.

Symptoms

Pseudoparalysis: inability to actively elevate arm above 90° despite intact passive motion
Cuff tear arthropathy: shoulder pain with crepitus, reduced strength, glenohumeral arthritis
Massive irreparable rotator cuff tear with associated arthritis
Displaced 3/4-part proximal humerus fracture in elderly (>70 years)
Failed previous shoulder arthroplasty (anatomic TSA, hemiarthroplasty)
Inflammatory arthritis (rheumatoid, psoriatic) with cuff destruction
Severe glenoid bone loss not amenable to anatomic reconstruction

Risk Factors

Age >65-70 years (ideal indication)
Female sex (more common in elderly population requiring rTSA)
Chronic rotator cuff disease progression
Acute trauma in elderly with osteoporotic 3/4-part proximal humerus fractures
Inflammatory arthritis with progressive cuff destruction
Failed previous shoulder surgery requiring revision
Functional demands compatible with reverse anatomy (avoid in young high-demand)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pseudoparalysis with inability to elevate arm
  • Massive rotator cuff tear with arthritis and shoulder pain
  • Cuff tear arthropathy with significant functional limitation
  • Displaced proximal humerus fracture in elderly patient
  • Failed previous shoulder replacement requiring revision
  • Severe shoulder arthritis with deficient rotator cuff
  • Considering reverse shoulder replacement for surgical evaluation

Treatment Methods

01
Comprehensive evaluation: clinical examination, plain radiographs (Hamada classification), CT for glenoid bone assessment and version planning, MRI for rotator cuff status
02
Conservative therapy trial: physical therapy focusing on deltoid strengthening, anti-inflammatory medication, intra-articular corticosteroid injections
03
Preoperative planning: implant selection (lateralized vs medialized), glenosphere size, baseplate type (standard, augmented, custom for severe bone loss), humeral component selection
04
Surgical approach: deltopectoral or anterosuperior, glenoid baseplate fixation with screws, glenosphere placement, humeral stem insertion, soft tissue balancing
05
Modern implants: cementless or cemented humeral stem, metal-backed glenoid baseplate with peg/screw fixation, polyethylene humeral cup
06
Postoperative protocol: sling immobilization 4-6 weeks, early passive motion, progressive active motion at 6 weeks, deltoid strengthening, return to activities at 3-6 months
07
Long-term follow-up: clinical assessment, periodic radiographs for component stability and scapular notching, monitoring for complications (instability, infection, acromial fracture)

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.