Reverse Glenohumeral Arthroplasty

[Jbeas]

Recently started a patient with this surgery. The ball and socket anatomy were reversed in the sx. humeral head now concave and glenoid now convex structure. Question(s): Does this change the arthrokinematics of this joint? Also if rotator cuff was never repaired and left unattatched then can we ever expext proper GH movements?

[Sillevis]

The reverse shoulder artroplasty brings its unique challange. First of all you have to be careful with the fact that subscapularis was detached dureing the procedure and this will requier adequate time to heal. If the rotator cuff tissue was not repaired can we still expect normal motion? I sugget that this will remain a patient with limited function. As it goes for the arthrokinematic function this indeed would be reversed and one could make an argument due to the replacement that joint glide doed not occur compared to tormal. The article by STEPHANIE BOUDREAU, PT, DPT1 • ED BOUDREAU, PT, OCS2 LAURENCE D. HIGGINS, MD3 • REG B. WILCOX III, PT, DPT, MS, OCS4 in JOSPT titled: Rehabilitation Following Reverse Total Shoulder Arthroplasty will hekp you out.

[Paula]

I believe this procedure is used more in Europe than US. This procedure is used for a significantly deficient RTC and/or severe arthropathy and my understanding is that they get good results. As previously stated I believe there will always be some limitation but more than if they had traditional shoulder arthroplasty or none at all. In my experience with traditional shoulder arthroplasty, the patient continues with moderately restricted movement at the GH jt nowhere near as successful as the knee or hip arthroplasty. I also believe the key and focus is on improving deltoid function with this procedure.

[Jbeas]

I believe the rotator cuff was not reattatched. So the common insertion of the infraspinatus and supraspinatus was not reattatched. The sub scapularis apears intact through MMT. So if the function of the rotator cuff is to assure proper position of the humeral head in the glenoid then that is not there anymore. Or is this not needed anymore secondary to the congruency of the replacement?