Shoulder:Glenohumeral Arthritis/Reverse Shoulder Arthroplasty - Revision history

Marko.nabergoj: Complications - section impingement

2021-11-15T21:34:29Z

Complications - section impingement

Alexandre.laedermann: /* Subscapularis Repair */

2021-09-10T10:34:11Z

Subscapularis Repair

Alexandre.laedermann: /* Subscapularis Repair */

2021-09-10T10:33:20Z

Subscapularis Repair

Alexandre.laedermann: /* Subscapularis Repair */

2021-09-10T10:30:31Z

Subscapularis Repair

Alexandre.laedermann at 06:57, 15 August 2021

2021-08-15T06:57:18Z

Alexandre.laedermann: /* Biomechanics */

2021-07-29T03:44:07Z

Biomechanics

Show changes

Alexandre.laedermann at 03:33, 29 July 2021

2021-07-29T03:33:38Z

Alexandre.laedermann at 03:32, 29 July 2021

2021-07-29T03:32:36Z

Alexandre.laedermann at 09:20, 1 June 2021

2021-06-01T09:20:17Z

Alexandre.laedermann at 09:11, 1 June 2021

2021-06-01T09:11:31Z

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 ===Impingements===
 ====Scapular Notching====
 Scapular notching is the most frequent radiographic change after a reverse shoulder arthroplasty and has been reported as high as 88%.<ref name=":37" /> It was initially described as the result of abutment of the prosthetic metaphysis against the scapular neck with the arm in adduction consequent to humerus medialization. Repetitive contact between polyethylene and bone may result in polyethylene wear debris, chronic inflammation and osteolysis,<ref name=":39" /> radiolucency around the glenoid component,<ref>Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005;87:1476-86</ref> loosening of the glenoid component,<ref>Cazeneuve JF, Cristofari DJ. Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. OOrthop Traumatol Surg Res 2009;95:325-9</ref> presence of an inferior bone spur, and ossification in the glenohumeral space.<ref name=":37" />

@@ Line 238: / Line 238: @@
 ====Subscapularis Repair====
-The healing rate of the subscapularis following reverse shoulder arthroplasty is only 52.6%.<ref>Collin P, Rol M, Muniandy M, Gain S, Lädermann A, Ode G. Relationship between postoperative integrity of subscapularis tendon and functional outcome in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30;S1058-2746(21)00523-1</ref> Internal rotation function in patients with an intact subscapularis at two years after reverse shoulder arthroplasty is significantly better than in patients with failed or absent tendon repairs. Primary repair of reparable subscapularis tendons during reverse shoulder arthroplasty should be thus strongly considered.
+The healing rate of the subscapularis following reverse shoulder arthroplasty is only 52.6%.<ref name=":0">Collin P, Rol M, Muniandy M, Gain S, Lädermann A, Ode G. Relationship between postoperative integrity of subscapularis tendon and functional outcome in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30;S1058-2746(21)00523-1</ref> Internal rotation function in patients with an intact subscapularis at two years after reverse shoulder arthroplasty is significantly better than in patients with failed or absent tendon repairs. Primary repair of reparable subscapularis tendons during reverse shoulder arthroplasty should be thus strongly considered.<ref name=":0" />
 ====Lesser Osteotomy Repair====

@@ Line 238: / Line 238: @@
 ====Subscapularis Repair====
-The healing rate of the subscapularis following reverse shoulder arthroplasty is only 52.6%. Internal rotation function in patients with an intact subscapularis at two years after reverse shoulder arthroplasty is significantly better than in patients with failed or absent tendon repairs. Primary repair of reparable subscapularis tendons during reverse shoulder arthroplasty should be thus strongly considered.
+The healing rate of the subscapularis following reverse shoulder arthroplasty is only 52.6%.<ref>Collin P, Rol M, Muniandy M, Gain S, Lädermann A, Ode G. Relationship between postoperative integrity of subscapularis tendon and functional outcome in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30;S1058-2746(21)00523-1</ref> Internal rotation function in patients with an intact subscapularis at two years after reverse shoulder arthroplasty is significantly better than in patients with failed or absent tendon repairs. Primary repair of reparable subscapularis tendons during reverse shoulder arthroplasty should be thus strongly considered.
 ====Lesser Osteotomy Repair====

@@ Line 238: / Line 238: @@
 ====Subscapularis Repair====
-This subsection does not exist. You can ask for it to be created, but consider checking the search results below to see whether the topic is already covered.
+The healing rate of the subscapularis following reverse shoulder arthroplasty is only 52.6%. Internal rotation function in patients with an intact subscapularis at two years after reverse shoulder arthroplasty is significantly better than in patients with failed or absent tendon repairs. Primary repair of reparable subscapularis tendons during reverse shoulder arthroplasty should be thus strongly considered.
 ====Lesser Osteotomy Repair====

@@ Line 174: / Line 174: @@
 ==Indications==
 Reverse shoulder arthroplasty is a powerful tool that has opened new barriers, especially for reconstructive shoulder surgery. Traditionally, the ideal candidate has been a patient above 70 years old with symptomatic cuff tear arthropathy. Appropriate candidates now include young patients, who have shown excellent clinical improvement with high implant survivorship of up to 10 years.<ref>Black EM, Roberts SM, Siegel E, Yannopoulos P, Higgins LD, Warner JJ. Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger. J Shoulder Elbow Surg 2014;23:1036-42</ref><ref>Ek ET, Neukom L, Catanzaro S, Gerber C. Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: Results after five to fifteen years. J Shoulder Elbow Surg 2013;22:1199-208</ref><ref>Muh SJ, Streit JJ, Wanner JP, Lenarz CJ, Shishani Y, Rowland DY, Riley C, Nowinski RJ, Edwards TB, Gobezie R. Early follow-up of reverse total shoulder arthroplasty in patients sixty years of age or younger. J Bone Joint Surg Am 2013;95:1877-83</ref><ref>Otto RJ, Clark RE, Frankle MA. Reverse shoulder arthroplasty in patients younger than 55 years: 2- to 12-year follow-up. J Shoulder Elbow Surg 2017;26:792-7</ref><ref>Sershon RA, Van Thiel GS, Lin EC, McGill KC, Cole BJ, Verma NN, Romeo AA, Nicholson GP. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elbow Surg 2014;23:395-400</ref><ref>Walters JD, Barkoh K, Smith RA, Azar FM, Throckmorton TW. Younger patients report similar activity levels to older patients after reverse total shoulder arthroplasty. J Shoulder Elbow Surg2016;25:1418-24</ref>
 Many pathologies that could not be treated previously found a solution through this design, and indications are currently expanding. It is now used for various conditions such as failed total shoulder arthroplasty or hemiarthroplasty, complex proximal humeral fractures and defective fracture union or nonunion, chronic locked dislocation, immunological arthritis with or without associated rotator cuff tears, failed or irreparable massive rotator cuff tears, and tumors.<ref>Smith CD, Guyver P, Bunker TD. Indications for reverse shoulder replacement: A systematic review. J Bone Joint Surg [Br] 2012;94:577-83</ref>
@@ Line 214: / Line 213: @@
 ==Contraindications==
 Absolute contraindications include general factors such as non compliance patients (severe psychiatric/neurologic disability, substance abuse), neuro-arthropathies (Charcot) and high patient morbidity (ASA 4+), and local factors like an uncontrolled active infection and substantial deltoid insufficiency because of the very high probability of recurrent instability and the minimal potential gain in function.<ref name=":23" />
 =Approaches=

@@ Line 42: / Line 42: @@
 ==Biomechanics==
-#REDIRECT [[Target page name]]
+#REDIRECT [[https://wiki.beemed.com/view/Shoulder:Biomechanics]]
 Reverse shoulder arthroplasty, often used in multiply operated patients with distorted anatomy, imparts physiological and biomechanical changes that may increase the potential for complications.<ref name=":5">Farshad M, Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop. 2010 Dec;34(8):1075-82</ref>

← Older revision		Revision as of 03:32, 29 July 2021
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	==Biomechanics==		==Biomechanics==
		+	#REDIRECT [[Target page name]]
	Reverse shoulder arthroplasty, often used in multiply operated patients with distorted anatomy, imparts physiological and biomechanical changes that may increase the potential for complications.<ref name=":5">Farshad M, Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop. 2010 Dec;34(8):1075-82</ref>		Reverse shoulder arthroplasty, often used in multiply operated patients with distorted anatomy, imparts physiological and biomechanical changes that may increase the potential for complications.<ref name=":5">Farshad M, Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop. 2010 Dec;34(8):1075-82</ref>

@@ Line 384: / Line 384: @@
 =Complications=
-The first series of reverse shoulder arthroplasty with an at least two years follow-up, confirmed the preliminary results with excellent functional outcome and stable glenoid fixation.<ref name=":36" /> Beck S, Patsalis T, Busch A, Dittrich F, Dudda M, Jäger M, Wegner A. A substantial and durable improvement in the long term has been reported.<ref>Long-term results of the reverse Total Evolutive Shoulder System (TESS). Arch Orthop Trauma Surg. 2019 Aug;139(8):1039-1044</ref><ref>Ernstbrunner L, Rahm S, Suter A, Imam MA, Catanzaro S, Grubhofer F, Gerber C. Salvage reverse total shoulder arthroplasty for failed operative treatment of proximal humeral fractures in patients younger than 60 years: long-term results. J Shoulder Elbow Surg. 2019 Oct 6. pii: S1058-2746(19)30537-3. doi: 10.1016/j.jse.2019.07.040. [Epub ahead of print]</ref><ref>van Ochten JHM, van der Pluijm M, Pouw M, Felsch QTM, Heesterbeek P, de Vos MJ. Long - Term survivorship and clinical and radiological follow - up of the primary uncemented Delta III reverse shoulder prosthesis. J Orthop. 2019 Mar 24;16(4):342-346</ref> However, the complexity of this procedure with regards to its singular anatomy and special patient population, is reflected by the large number of reported problems and complications. As defined by Zumstein et al., problems can be defined as intra- or postoperative events that are not likely to affect the patient’s final outcome.<ref name=":19">Zumstein MA1, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011 Jan;20(1):146-57</ref> This will include hematomas, phlebitis, heterotopic ossification, algodystrophy and will not be part of the treated subjects of this thesis. Complications are defined as any intra- or postoperative events that are likely to have a negative influence on the patient’s final outcome, such as intraoperative cement extravasation, intra- or postoperative fractures, dislocations, infections, neurological lesions, radiographic changes such as glenoid or humeral lucent lines, scapular notching, stress shielding, aseptic loosening, reinterventions (without replacement of the component) or revisions (with replacement of the component).
+The first series of reverse shoulder arthroplasty with an at least two years follow-up, confirmed the preliminary results with excellent functional outcome and stable glenoid fixation.<ref name=":36" /> Beck S, Patsalis T, Busch A, Dittrich F, Dudda M, Jäger M, Wegner A. A substantial and durable improvement in the long term has been reported.<ref>Beck S, Patsalis T, Busch A, Dittrich F, Dudda M, Jäger M, Wegner A. Long-term results of the reverse Total Evolutive Shoulder System (TESS). Arch Orthop Trauma Surg. 2019 Aug;139(8):1039-1044</ref><ref>Ernstbrunner L, Rahm S, Suter A, Imam MA, Catanzaro S, Grubhofer F, Gerber C. Salvage reverse total shoulder arthroplasty for failed operative treatment of proximal humeral fractures in patients younger than 60 years: long-term results. J Shoulder Elbow Surg. 2019 Oct 6. pii: S1058-2746(19)30537-3.</ref><ref>van Ochten JHM, van der Pluijm M, Pouw M, Felsch QTM, Heesterbeek P, de Vos MJ. Long - Term survivorship and clinical and radiological follow - up of the primary uncemented Delta III reverse shoulder prosthesis. J Orthop. 2019 Mar 24;16(4):342-346</ref> However, the complexity of this procedure with regards to its singular anatomy and special patient population, is reflected by the large number of reported problems and complications. As defined by Zumstein et al., problems can be defined as intra- or postoperative events that are not likely to affect the patient’s final outcome.<ref name=":19">Zumstein MA1, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011 Jan;20(1):146-57</ref> This will include hematomas, phlebitis, heterotopic ossification, algodystrophy and will not be part of the treated subjects of this thesis. Complications are defined as any intra- or postoperative events that are likely to have a negative influence on the patient’s final outcome, such as intraoperative cement extravasation, intra- or postoperative fractures, dislocations, infections, neurological lesions, radiographic changes such as glenoid or humeral lucent lines, scapular notching, stress shielding, aseptic loosening, reinterventions (without replacement of the component) or revisions (with replacement of the component).
 ==Radiological Changes==
-This is the most frequently reported complication after reverse shoulder arthroplasty.<ref name=":19" /> Long-term studies reported their prevalence.<ref name=":0">Mélis B, Defranco M, Lädermann A, Molé D, Favard L, Nérot C, Maynou C, Walch G. An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years. J Bone Joint Surg Br 2011;93:1240-1246</ref>
+This is the most frequently reported complication after reverse shoulder arthroplasty.<ref name=":19" /> Long-term studies reported their prevalence.<ref name=":37" />
 ===Impingements===
 ====Scapular Notching====
-Scapular notching is the most frequent radiographic change after a reverse shoulder arthroplasty and has been reported as high as 88%.<ref name=":0" /> It was initially described as the result of abutment of the prosthetic metaphysis against the scapular neck with the arm in adduction consequent to humerus medialization. Repetitive contact between polyethylene and bone may result in polyethylene wear debris, chronic inflammation and osteolysis,<ref name=":39" /> radiolucency around the glenoid component,<ref>Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005;87:1476-86</ref> loosening of the glenoid component,<ref>Cazeneuve JF, Cristofari DJ. Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. OOrthop Traumatol Surg Res 2009;95:325-9</ref> presence of an inferior bone spur, and ossification in the glenohumeral space.<ref name=":0" />
+Scapular notching is the most frequent radiographic change after a reverse shoulder arthroplasty and has been reported as high as 88%.<ref name=":37" /> It was initially described as the result of abutment of the prosthetic metaphysis against the scapular neck with the arm in adduction consequent to humerus medialization. Repetitive contact between polyethylene and bone may result in polyethylene wear debris, chronic inflammation and osteolysis,<ref name=":39" /> radiolucency around the glenoid component,<ref>Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005;87:1476-86</ref> loosening of the glenoid component,<ref>Cazeneuve JF, Cristofari DJ. Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. OOrthop Traumatol Surg Res 2009;95:325-9</ref> presence of an inferior bone spur, and ossification in the glenohumeral space.<ref name=":37" />
-Scapular notching (Figure 37) typically occurs within six months after surgery and appears to stabilize in most cases. The use of an anterosuperior approach, a high position of the baseplate on the glenoid and superior tilting have all been associated with higher rates of notching caused by mechanical impingement with the arm in adduction. Eccentric glenospheres with an inferior offset and glenoid components with a more lateral offset (bony or metal) can reduce the risk of notching.<ref name=":9">Lädermann A, Denard PJ, Collin P, Zbinden O, Chiu JC, Boileau P, Olivier F, Walch G. Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty. Int Orthop. 2020;44(3):519-530</ref><ref name=":3" /> Mizuno et al. analyzed the influence of an eccentric glenosphere in 47 consecutive cases compared with a historical group treated by the same surgeon. The rates of notching were not different but the severity of notching was less when using an eccentric glenosphere.<ref name=":38" /> Other authors have reported a negligible rate of notching when using an inferior offset component.
+Scapular notching (Figure 37) typically occurs within six months after surgery and appears to stabilize in most cases. The use of an anterosuperior approach, a high position of the baseplate on the glenoid and superior tilting have all been associated with higher rates of notching caused by mechanical impingement with the arm in adduction. Eccentric glenospheres with an inferior offset and glenoid components with a more lateral offset (bony or metal) can reduce the risk of notching.<ref name=":11" /><ref name=":3" /> Mizuno et al. analyzed the influence of an eccentric glenosphere in 47 consecutive cases compared with a historical group treated by the same surgeon. The rates of notching were not different but the severity of notching was less when using an eccentric glenosphere.<ref name=":38" /> Other authors have reported a negligible rate of notching when using an inferior offset component.

@@ Line 311: / Line 311: @@
 Effectively, as the Blix curve describes, maintenance of length is required for a muscle to generate adequate tension.<ref>Blix M. Die lange und dle spannung des muskels. Skand Arch Physiol 1891:295-318</ref> Therefore shortening either by proximal migration of the deltoid insertion (rotator cuff arthropathy) or distal migration of the origin (scapular spine fracture) will compromise deltoid function. Proximal migration in particular can be considered a transient cause of deltoid impairment since it can be treated with reverse shoulder arthroplasty. Distal migration, on the other hand, may be permanent or transient depending on the situation.
-In the most severe conditions, part or all of the deltoid muscle may be completely absent. Such permanent impairment is rare but may be observed following deltoid muscular flap transfer (for irreparable rotator cuff tears, Figure 27)<ref>Gazielly D. The deltoid flap procedure. Tech Shoulder Elbow Surg 2000:117–27</ref><ref>Glanzmann MC, Flury M, Simmen BR. Reverse shoulder arthroplasty as salvage procedure after deltoid muscle flap transfer for irreparable rotator cuff tear: a case report. J Shoulder Elbow Surg 2009;18:e1-2</ref><ref name=":20">Tay AK, Collin P. Irreparable spontaneous deltoid rupture in rotator cuff arthropathy: the use of a reverse total shoulder replacement. J Shoulder Elbow Surg 2011;20:e5-8</ref> or following tumor resection (Figure 28).
+In the most severe conditions, part or all of the deltoid muscle may be completely absent. Such permanent impairment is rare but may be observed following deltoid muscular flap transfer (for irreparable rotator cuff tears, Figure 27)<ref>Gazielly D. The deltoid flap procedure. Tech Shoulder Elbow Surg 2000:117–27</ref><ref name=":42">Glanzmann MC, Flury M, Simmen BR. Reverse shoulder arthroplasty as salvage procedure after deltoid muscle flap transfer for irreparable rotator cuff tear: a case report. J Shoulder Elbow Surg 2009;18:e1-2</ref><ref name=":20">Tay AK, Collin P. Irreparable spontaneous deltoid rupture in rotator cuff arthropathy: the use of a reverse total shoulder replacement. J Shoulder Elbow Surg 2011;20:e5-8</ref> or following tumor resection (Figure 28).
 [[File:Image22-59.jpg|thumb|center| Figure 27. Status after a left deltoid muscular flap transfer for irreparable rotator cuff tears. A: Schematic drawing of the surgical technique (with permission of Gazielly D.). B: Frontal magnetic resonance imaging demonstrates absence of the deltoid muscle laterally. C. Clinical photo demonstrating atrophy of the anterior and middle deltoid.]]
@@ Line 338: / Line 338: @@
 ====Results====
-Glanzmann et al. first published a case report of the results of a reverse shoulder arthroplasty after deltoid muscle flap transfer.<ref>Glanzmann MC, Flury M, Simmen BR. Reverse shoulder arthroplasty as salvage procedure after deltoid muscle flap transfer for irreparable rotator cuff tear: a case report. J Shoulder Elbow Surg 2009;18:e1-2</ref> At two years follow-up, the patient was satisfied and had a Constant score of 62 points, suggesting that the entire deltoid may not be necessary for a successful outcome. Tay and Collin also described successful results of a reverse shoulder arthroplasty implanted in the setting of an irreparable rupture of the middle portion of the deltoid muscle.<ref name=":20" /> No intra- or postoperative complication was noticed. At two years follow-up, the patient was pain free, had active anterior elevation of 150 degrees, and the Constant score was 65 points. Gulotta et al. reported in their biomechanical study that scapular plane elevation may still be possible following a reverse shoulder arthroplasty in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid.<ref>Gulotta LV, Choi D, Marinello P, Wright T, Cordasco FA, Craig EV, Warren RF. Anterior deltoid deficiency in reverse total shoulder replacement: a biomechanical study with cadavers. J Bone Joint Surg Br 2012;94:1666-9</ref> In this condition, surgeons should focus on preserving the subscapularis as much as possible during approach of reverse shoulder arthroplasty. Whatley et al. reported three cases who had postoperative rupture of the anterolateral deltoid following failed mini-open or open rotator cuff repairs. Successful repair of the deltoid was achieved using a transosseous suture repair in all three patients.<ref>Whatley AN, Fowler RL, Warner JJ, Higgins LD. Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair. J Shoulder Elbow Surg 2011;20:114-22</ref> Essilfie et al. presented a case with deltoid failure after anatomical total shoulder arthroplasty revised with reverse shoulder arthroplasty. His ASES score after reverse shoulder arthroplasty was better than historical outcomes for resection arthroplasty and glenohumeral arthrodesis.<ref>Essilfie A, McKnight B, Heckmann N, Rick Hatch GF, 3rd, Omid R. Revision reverse total shoulder arthroplasty in a patient with preoperative deltoid insufficiency: a case report. J Shoulder Elbow Surg 2017;26:e232-e5</ref> Lattisimus dorsi muscle transfer can also provide an augmentation in patients with deltoid insufficiency.<ref>Dosari M, Hameed S, Mukhtar K, Elmhiregh A. Reverse shoulder arthroplasty for deltoid-deficient shoulder following latissimus dorsi flap transfer. Case report. Int J Surg Case Rep 2017;39:256-9</ref><ref>Goel DP, Ross DC, Drosdowech DS. Rotator cuff tear arthropathy and deltoid avulsion treated with reverse total shoulder arthroplasty and latissimus dorsi transfer: case report and review of the literature. J Shoulder Elbow Surg 2012;21:e1-7</ref> Dosari et al. presented a patient with a history of gunshot injury and loss of most of his shoulder bony and muscular structures. Due to deltoid muscle deficiency, the patient underwent lattisimus dorsi muscle flap followed by reverse shoulder arthroplasty with successful result.<ref>Dosari M, Hameed S, Mukhtar K, Elmhiregh A. Reverse shoulder arthroplasty for deltoid-deficient shoulder following latissimus dorsi flap transfer. Case report. Int J Surg Case Rep 2017;39:256-9</ref> Deltoid reconstruction at the same time of reverse shoulder arthroplasty is also a viable choice as a salvage procedure for patients with deltoid deficiency.<ref name=":25">Marinello PG, Amini MH, Peers S, O'Donnell J, Iannotti JP. Reverse total shoulder arthroplasty with combined deltoid reconstruction in patients with anterior and/or middle deltoid tears. J Shoulder Elbow Surg 2016;25:936-41</ref> Marinello suggested if less than 50% of any part of the anterior or middle deltoid was involved (≤3 cm), reattachment or reconstruction was not needed. If all of the anterior and/or middle deltoid were involved, then reattachment or reconstruction was indicated.<ref name=":25" /> In a multicentered study, Lädermann et al. reviewed 49 patients (49 shoulders) at a mean of 38 ± 30 months postoperative following reverse shoulder arthroplasty in the setting of deltoid impairment.<ref name=":23" /> Postoperative complications occurred in nine (18%) patients, including two postoperative dislocations and two acute postoperative neurological lesions. Five (10%) patients required additional surgery. Active forward elevation and Constant score improved significantly. However, these values are significantly lower for patients suffering from global deltoid impairment (type 4) compared to types 1 through 3. The mean postoperative forward elevation was lower in the setting of global deltoid impairment (70 degrees) compared to partial impairment (127 degrees, 136 degrees and 125 degrees, groups 1-3 respectively) (P=.002). The postoperative Constant score was lower in the setting of global impairment (41) compared to partial impairment (57, 63 and 68, groups 1-3 respectively) (P=.006). Overall, the rate of patient satisfaction was 98% at final follow-up.<ref name=":23" /> Schneeberger et al. retrospectively reviewed the outcome of 19 patients treated with reverse shoulder arthroplasty after failed deltoid flap reconstruction.<ref>Schneeberger AG, Muller TM, Steens W, Thur C. Reverse total shoulder arthroplasty after failed deltoid flap reconstruction. Arch Orthop Trauma Surg 2014;134:317-23</ref> They noticed a high rate of complication (37%), including one instability. Nonetheless, at a mean follow-up of 4.5 years, only two patients had moderate to severe pain, all patients regained anterior active elevation above 90 degrees, and 15 of 19 patients were very satisfied.
+Glanzmann et al. first published a case report of the results of a reverse shoulder arthroplasty after deltoid muscle flap transfer.<ref name=":42" /> At two years follow-up, the patient was satisfied and had a Constant score of 62 points, suggesting that the entire deltoid may not be necessary for a successful outcome. Tay and Collin also described successful results of a reverse shoulder arthroplasty implanted in the setting of an irreparable rupture of the middle portion of the deltoid muscle.<ref name=":20" /> No intra- or postoperative complication was noticed. At two years follow-up, the patient was pain free, had active anterior elevation of 150 degrees, and the Constant score was 65 points. Gulotta et al. reported in their biomechanical study that scapular plane elevation may still be possible following a reverse shoulder arthroplasty in the setting of anterior deltoid deficiency. When the anterior deltoid is deficient, there is a compensatory increase in the force required by the subscapularis and middle deltoid.<ref>Gulotta LV, Choi D, Marinello P, Wright T, Cordasco FA, Craig EV, Warren RF. Anterior deltoid deficiency in reverse total shoulder replacement: a biomechanical study with cadavers. J Bone Joint Surg Br 2012;94:1666-9</ref> In this condition, surgeons should focus on preserving the subscapularis as much as possible during approach of reverse shoulder arthroplasty. Whatley et al. reported three cases who had postoperative rupture of the anterolateral deltoid following failed mini-open or open rotator cuff repairs. Successful repair of the deltoid was achieved using a transosseous suture repair in all three patients.<ref>Whatley AN, Fowler RL, Warner JJ, Higgins LD. Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair. J Shoulder Elbow Surg 2011;20:114-22</ref> Essilfie et al. presented a case with deltoid failure after anatomical total shoulder arthroplasty revised with reverse shoulder arthroplasty. His ASES score after reverse shoulder arthroplasty was better than historical outcomes for resection arthroplasty and glenohumeral arthrodesis.<ref>Essilfie A, McKnight B, Heckmann N, Rick Hatch GF, 3rd, Omid R. Revision reverse total shoulder arthroplasty in a patient with preoperative deltoid insufficiency: a case report. J Shoulder Elbow Surg 2017;26:e232-e5</ref> Lattisimus dorsi muscle transfer can also provide an augmentation in patients with deltoid insufficiency.<ref name=":43">Dosari M, Hameed S, Mukhtar K, Elmhiregh A. Reverse shoulder arthroplasty for deltoid-deficient shoulder following latissimus dorsi flap transfer. Case report. Int J Surg Case Rep 2017;39:256-9</ref><ref>Goel DP, Ross DC, Drosdowech DS. Rotator cuff tear arthropathy and deltoid avulsion treated with reverse total shoulder arthroplasty and latissimus dorsi transfer: case report and review of the literature. J Shoulder Elbow Surg 2012;21:e1-7</ref> Dosari et al. presented a patient with a history of gunshot injury and loss of most of his shoulder bony and muscular structures. Due to deltoid muscle deficiency, the patient underwent lattisimus dorsi muscle flap followed by reverse shoulder arthroplasty with successful result.<ref name=":43" /> Deltoid reconstruction at the same time of reverse shoulder arthroplasty is also a viable choice as a salvage procedure for patients with deltoid deficiency.<ref name=":25">Marinello PG, Amini MH, Peers S, O'Donnell J, Iannotti JP. Reverse total shoulder arthroplasty with combined deltoid reconstruction in patients with anterior and/or middle deltoid tears. J Shoulder Elbow Surg 2016;25:936-41</ref> Marinello suggested if less than 50% of any part of the anterior or middle deltoid was involved (≤3 cm), reattachment or reconstruction was not needed. If all of the anterior and/or middle deltoid were involved, then reattachment or reconstruction was indicated.<ref name=":25" /> In a multicentered study, Lädermann et al. reviewed 49 patients (49 shoulders) at a mean of 38 ± 30 months postoperative following reverse shoulder arthroplasty in the setting of deltoid impairment.<ref name=":23" /> Postoperative complications occurred in nine (18%) patients, including two postoperative dislocations and two acute postoperative neurological lesions. Five (10%) patients required additional surgery. Active forward elevation and Constant score improved significantly. However, these values are significantly lower for patients suffering from global deltoid impairment (type 4) compared to types 1 through 3. The mean postoperative forward elevation was lower in the setting of global deltoid impairment (70 degrees) compared to partial impairment (127 degrees, 136 degrees and 125 degrees, groups 1-3 respectively) (P=.002). The postoperative Constant score was lower in the setting of global impairment (41) compared to partial impairment (57, 63 and 68, groups 1-3 respectively) (P=.006). Overall, the rate of patient satisfaction was 98% at final follow-up.<ref name=":23" /> Schneeberger et al. retrospectively reviewed the outcome of 19 patients treated with reverse shoulder arthroplasty after failed deltoid flap reconstruction.<ref>Schneeberger AG, Muller TM, Steens W, Thur C. Reverse total shoulder arthroplasty after failed deltoid flap reconstruction. Arch Orthop Trauma Surg 2014;134:317-23</ref> They noticed a high rate of complication (37%), including one instability. Nonetheless, at a mean follow-up of 4.5 years, only two patients had moderate to severe pain, all patients regained anterior active elevation above 90 degrees, and 15 of 19 patients were very satisfied.
 It seems that the most important factor for postoperative result is the extent of the lesion, and not its cause. Interestingly, patient satisfaction is high in all publications on reverse shoulder arthroplasty in the setting of deltoid impairment. However, this is likely related to very poor preoperative function and moderate preoperative expectations of this population.
@@ Line 381: / Line 381: @@
 =Results=
-With a mean anterior forward flexion of 137 degrees and a mean external rotation elbow at the side of 6 degrees, reverse shoulder arthroplasty typically provides satisfactory clinical outcomes for a variety of complex shoulder diagnoses associated with severe pain and limitation of range of motion.<ref name=":26">Wall B, Nove-Josserand L, O'Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007;89:1476-85</ref> However, some patients have had unexpectedly poor functional improvements after reverse shoulder arthroplasty.<ref name=":26" /> Poor postoperative range of motion following reverse shoulder arthroplasty, has been associated with younger age,<ref>Hartzler RU, Steen BM, Hussey MM, Cusick MC, Cottrell BJ, Clark RE, Frankle MA. Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement. J Shoulder Elbow Surg 2015;24:1698-706</ref> gender,<ref>Schwartz DG, Cottrell BJ, Teusink MJ, Clark RE, Downes KL, Tannenbaum RS, Frankle MA. Factors that predict postoperative motion in patients treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014 Sep;23(9):1289-95</ref> surgeon experience,<ref>Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ. Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon's experience? J Shoulder Elbow Surg. 2012 Nov;21(11):1470-7</ref> preoperative diagnosis such as posttraumatic arthritis and revision arthroplasty,<ref>Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 2008;90:1244-51.</ref><ref>Wall B, Nove-Josserand L, O'Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007;89:1476-85</ref> pre- and intraoperative range of motion or deltoid impairment,<ref name=":23" /><ref>Schwartz DG, Cottrell BJ, Teusink MJ, Clark RE, Downes KL, Tannenbaum RS, Frankle MA. Factors that predict postoperative motion in patients treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014 Sep;23(9):1289-95</ref> postoperative arm lengthening<ref name=":32" /><ref>Lädermann A, Lubbeke A, Collin P, Edwards TB, Sirveaux F, Walch G. Influence of surgical approach on functional outcome in reverse shoulder arthroplasty. Orthopaedics & traumatology, surgery & research : OTSR 2011;97:579-82</ref><ref name=":30" /> or neurological lesion.<ref>Hartzler RU, Steen BM, Hussey MM, Cusick MC, Cottrell BJ, Clark RE, Frankle MA. Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement. J Shoulder Elbow Surg 2015;24:1698-706</ref><ref>Lädermann A, Lübbeke A, Mélis B, Stern R, Christofilopoulos P, Bacle G, Walch G. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am 2011;93:1288-93</ref> Surgery of the non-dominant side, lower preoperative range of motion, and lower functional outcome scores preoperatively are predictive of a slower recovery of active anterior forward flexion after reverse shoulder arthroplasty.<ref>Collin P, Matsukawa T, Denard PJ, Gain S, Lädermann A.Pre-operative factors influence the recovery of range of motion following reverse shoulder arthroplasty. Int Orthop. 2017 Oct;41(10):2135-2142</ref>
+With a mean anterior forward flexion of 137 degrees and a mean external rotation elbow at the side of 6 degrees, reverse shoulder arthroplasty typically provides satisfactory clinical outcomes for a variety of complex shoulder diagnoses associated with severe pain and limitation of range of motion.<ref name=":26">Wall B, Nove-Josserand L, O'Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007;89:1476-85</ref> However, some patients have had unexpectedly poor functional improvements after reverse shoulder arthroplasty.<ref name=":26" /> Poor postoperative range of motion following reverse shoulder arthroplasty, has been associated with younger age,<ref name=":44">Hartzler RU, Steen BM, Hussey MM, Cusick MC, Cottrell BJ, Clark RE, Frankle MA. Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement. J Shoulder Elbow Surg 2015;24:1698-706</ref> gender,<ref name=":45">Schwartz DG, Cottrell BJ, Teusink MJ, Clark RE, Downes KL, Tannenbaum RS, Frankle MA. Factors that predict postoperative motion in patients treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014 Sep;23(9):1289-95</ref> surgeon experience,<ref>Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ. Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon's experience? J Shoulder Elbow Surg. 2012 Nov;21(11):1470-7</ref> preoperative diagnosis such as posttraumatic arthritis and revision arthroplasty,<ref>Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 2008;90:1244-51.</ref><ref name=":26" /> pre- and intraoperative range of motion or deltoid impairment,<ref name=":23" /><ref name=":45" /> postoperative arm lengthening<ref name=":32" /><ref>Lädermann A, Lubbeke A, Collin P, Edwards TB, Sirveaux F, Walch G. Influence of surgical approach on functional outcome in reverse shoulder arthroplasty. Orthopaedics & traumatology, surgery & research : OTSR 2011;97:579-82</ref><ref name=":30" /> or neurological lesion.<ref name=":44" /><ref name=":46">Lädermann A, Lübbeke A, Mélis B, Stern R, Christofilopoulos P, Bacle G, Walch G. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am 2011;93:1288-93</ref> Surgery of the non-dominant side, lower preoperative range of motion, and lower functional outcome scores preoperatively are predictive of a slower recovery of active anterior forward flexion after reverse shoulder arthroplasty.<ref>Collin P, Matsukawa T, Denard PJ, Gain S, Lädermann A.Pre-operative factors influence the recovery of range of motion following reverse shoulder arthroplasty. Int Orthop. 2017 Oct;41(10):2135-2142</ref>
 =Complications=
@@ Line 419: / Line 419: @@
 ==Neurological Lesions==
-Lengthening of the arm during reverse shoulder arthroplasty, because of its nonanatomic design and/or maneuver of glenohumeral reduction, may be a major factor responsible for the increased prevalence of neurologic injury. Clinically relevant neurological complications involving the brachial plexus or the axillary nerve, however, are rare following reverse shoulder arthroplasty. A prospective study determined the electrodiagnostic occurrence of peripheral nerve lesions following 155 degrees neck shaft angle reverse shoulder arthroplasty.<ref>Lädermann A1, Lübbeke A, Mélis B, Stern R, Christofilopoulos P, Bacle G, Walch G. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011 Jul 20;93(14):1288-93</ref> If one also takes into account subclinical deterioration of preoperative lesions, 63% of patients in this study had postoperative neurologic lesions. However, only 5% of patients had a lesion that was present beyond 6 months postoperative. The rate of postoperative lesions seems lower using low neck shaft angles.<ref>Lowe JT, Lawler SM, Testa EJ, Jawa A. Lateralization of the glenosphere in reverse shoulder arthroplasty decreases arm lengthening and demonstrates comparable risk of nerve injury compared with anatomic arthroplasty: a prospective cohort study. J Shoulder Elbow Surg. 2018 Oct;27(10):1845-1851</ref> It seems consequently that distalization put the nerve at risk and that lateralization is rather protective for the plexus.
+Lengthening of the arm during reverse shoulder arthroplasty, because of its nonanatomic design and/or maneuver of glenohumeral reduction, may be a major factor responsible for the increased prevalence of neurologic injury. Clinically relevant neurological complications involving the brachial plexus or the axillary nerve, however, are rare following reverse shoulder arthroplasty. A prospective study determined the electrodiagnostic occurrence of peripheral nerve lesions following 155 degrees neck shaft angle reverse shoulder arthroplasty.<ref name=":46" /> If one also takes into account subclinical deterioration of preoperative lesions, 63% of patients in this study had postoperative neurologic lesions. However, only 5% of patients had a lesion that was present beyond 6 months postoperative. The rate of postoperative lesions seems lower using low neck shaft angles.<ref>Lowe JT, Lawler SM, Testa EJ, Jawa A. Lateralization of the glenosphere in reverse shoulder arthroplasty decreases arm lengthening and demonstrates comparable risk of nerve injury compared with anatomic arthroplasty: a prospective cohort study. J Shoulder Elbow Surg. 2018 Oct;27(10):1845-1851</ref> It seems consequently that distalization put the nerve at risk and that lateralization is rather protective for the plexus.