Reverse total shoulder - is it always the right choice for cuff tear arthropathy?

Below are the x-rays and MRI of a man who was 75 years old at the time of presentation with severe cuff tear arthropathy and an irreparable cuff tear. He had a large degenerative cyst in is proximal humerus. We suspect in many hands this would lead to a reverse total shoulder.

We performed an impaction grafted CTA arthroplasty because of his desire for a high level of activity and because he had neither pseudo paralysis or anterior superior escape.

Two and a half years later he presented because of an acute tear in his opposite rotator cuff. He reported having no pain in the shoulder with the CTA arthroplasty and demonstrated a full range of active motion. He had returned to all his desired activities, including golf and heavy duty gardening.
Here are his followup films.

Comment: This case, along with many others, show that arthritis and cuff deficiency do not always need to be treated with a reverse total shoulder. If ever this CTA arthroplasty fails (which in our experience is very unlikely), conversion of this uncemented arthroplasty to a reverse total shoulder would be easy.

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