This article concerns a substantial series of shoulders having reverse total shoulder arthroplasty by a very experienced surgeon, who was the primary orthopaedic designer of the implant used. The indications for surgery included primary rotator cuff deficiency, failed previous rotator cuff repairs, failed previous arthroplasty, and proximal humeral nonunion. Average age was 70 (52-88) years. Ninety-four percent of the implants survived at 60 months after surgery. There were three revisions for instability, one for component loosening, and one for allograft resorption. Simple shoulder test scores improved from an average of 2 preoperatively to 7 at two years; there was no loss of SST function at the most recent followup (minimum five years).
Radiographic analysis showed two shoulders with humeral radiolucencies and seven with low grade scapular notching. There were no failures of the baseplate.
This is an important update on the functional and radiographic results after this procedure. The absence of baseplate failure is of particular interest because of the fact that this prosthesis places the center of rotation in a more lateral position than other designs.
The low complication rate in this complex group of patients is impressive in comparison to other reports.
We will will observe with great interest the different series being reported by different surgeons, in different patients with different diagnoses, and with different implants in an attempt to understand the factors predisposing to good and poor results with the reverse total shoulder. Is it the surgeon, the patient, the shoulder, the prosthesis, the specifics of the technique or the rehabilitation that makes the difference?
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