Short term results of reverse total shoulder arthroplasty

Shoulder arthroplasty audit is the evidence based process of reviewing the delivery of care, to monitor the short term and long term measures of shoulder replacements. It has been used to evaluate the patient reported functional and objective outcomes, surgeon related experience and implant related radiological outcomes and survivorship. An audit is used to improve the quality of care and to give impetus for future research. Arthroplasty of the shoulder offers pain relief and improved function when the native gleno-humeral articulation is affected by arthritis, trauma and cuff arthropathy. Surgeons have acknowledged the stabilizing role of the rotator cuff and noted that the loss of these stabilizers may lead to additional force on the implant.¹ It was also noted that the patients with a deficient rotator cuff, had problems with shoulder replacement as the prime movers of the shoulder were unable to act in the absence of a stabilizing force of the rotator cuff. Reverse total shoulder arthroplasty (RTSA) initially gained popularity in the treatment of the patients with insufficient rotator cuffs and arthritis, nowadays the indications have expanded and surgeons are including this technique to treat proximal humeral fractures, massive rotator cuff tears without glenohumeral arthritis, revision arthroplasty, and glenohumeral osteoarthritis in the setting of irreparable rotator cuff tears.² Many new models of reverse shoulder arthroplasty have been introduced in the hope to improve implant survivorship, to reduce the rates of complication and to increase post-operative function, but still only limited follow up has been reported.^3,4 At present, there are a plethora of different reverse designs from companies such as Tornier, Zimmer, DJO Surgical (formerly Encore Medical), Exactech, Biomet and Lima LTO. Each one has its benefits and drawbacks, but they all are based on the same principle of reversing normal shoulder anatomy. The aim of this studywas to review the results of the patients who underwent an operation and received a reverse shoulder replacement between 2010 and 2015. The objectives of this study were to retrieve the information from the database regarding the patients’ demographics, pre-operative diagnosis, range of motion, x rays and indications for surgery, to recall the post-operative patients for clinical and objective evaluation, to invite all those patients to complete validated questionnaires both retrospectively for pre-operative function and prospectively for their post-operative function, to obtain survivorship data and post-operative function at a mean follow-up period, to obtain and compare the functional outcomes between the patients who underwent reverse shoulder arthroplasty for glenohumeral arthritis with cuff tear arthropathy and proximal humerus fractures and to discuss the complications regarding the mechanism of failure in patients operated with reverse total shoulder arthroplasty.