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Reverse Total Shoulder Arthroplasty

Dr. Gerber is Professor and Chairman, Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. Dr. Pennington is former Fellow, Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, and is currently Shoulder Surgeon, Peachtree Orthopaedic Clinic, Atlanta, GA. Dr. Nyffeler is Head of Shoulder and Elbow Surgery, Department of Orthopaedics, University of Bern, Inselspital, Bern, Switzerland.

Dr. Gerber or a member of his immediate family serves as a board member, owner, officer, or committee member of the Swiss Society of Orthopaedic Surgery, is affiliated with the publication Shoulder and Elbow Surgery, has received royalties from Zimmer, serves as a paid consultant to Storz, and has received research or institutional support from Zimmer Medacta. Neither of the following authors nor a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pennington and Dr. Nyffeler.

Reprint requests: Dr. Gerber, Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.

The radical changes in prosthetic design made in the mid 1980s transformed the historically poorly performing reverse ball-and-socket total shoulder prosthesis into a highly successful salvage implant for pseudoparalytic, severely rotator cuff–deficient shoulders. Moving the center of rotation more medial and distal as well as implanting a large glenoid hemisphere that articulates with a humeral cup in 155° of valgus are the biomechanical keys to sometimes spectacular short- to mid-term results. Use of the reverse total shoulder arthroplasty device allows salvage of injuries that previously were beyond surgical treatment. However, this technique has a complication rate approximately three times that of conventional arthroplasty. Radiographic and clinical results appear to deteriorate over time. Proper patient selection and attention to technical details are needed to reduce the currently high complication rate.