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Stemless Reverse Total Shoulder Arthroplasty Surgical Technique and 10 Years Results

February 19, 2016

Contributors: Ofer Levy, MD; Ofer Levy, MD

Keywords: Bony Procedure

Introduction: Recently, reverse shoulder arthroplasty has increased in popularity, resulting in good results; however, the high complication rate, high incidence of glenoid notching, and considerable revision surgery rate are concerns. Revision surgery is associated with a potential serious problem in stem removal. We have been using a novel, stemless, triple-finned reverse shoulder prosthesis that is different from all other known shoulder implants. This video describes the surgical technique for reverse total shoulder arthroplasty via this bone-preserving reverse prosthesis with metaphyseal fixation, providing step-by-step instructions and reporting 10-years results. Tips and tricks to make reverse total shoulder arthroplasty more simple with better outcomes are presented. Methods: Between 2005 and 2014, 275 patients underwent stemless reverse total shoulder arthroplasty for the management of severe rotator cuff deficiency and arthritis. The mean patient age at the time of surgery was 74.4 years (range, 38 to 93 years). The etiology for surgery was rotator cuff arthropathy, fracture sequelae, rheumatoid arthritis, failed rotator cuff repair, revision surgery for loosening of anatomic prosthesis or rotator cuff failure with anatomic prostheses, and acute trauma. Results: Patients had good pain relief and high satisfaction scores, with substantial improvement in function and Constant assessment scores. The mean range of movement improved to 128.5° of elevation, 50.8° of external rotation, and 64.6° of internal rotation. Discussion and Conclusion: This different prosthesis design without a stem is associated with encouraging midterm results, with excellent pain relief and restoration of good active range of motion and good shoulder function. Patient satisfaction scores substantially improved. The new design principles are associated with a low incidence of glenoid notching and improved rotational movements, with return to full activities, including sports. Radiographic assessment revealed a 21% rate of mild glenoid notching, no lucencies about the implants, and no signs of stress shielding or subsidence. With this stemless, bone-preserving procedure, all options are available for future surgery, if necessary, because bone stock is preserved. Therefore, this prosthesis also may be used in younger patients.