Indications for reverse shoulder arthroplasty in 2020: What has changed?

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Paul Grammont developed the reverse total shoulder arthroplasty (RTSA) in the 1980s as a treatment for rotator cuff tear arthropathy in the elderly.23 It demonstrated excellent clinical outcomes and has thus become well-established as the treatment of choice for cuff tear arthropathy. Increasing surgeon experience with the reverse prosthesis has seen a decrease in complications.57 As a result, over the last 15 years the indications for RTSA have seen a huge expansion. The Australian National Joint Registry shows the proportion of primary total shoulder arthroplasty (TSA) cases that are reverses has increased from 42.2% in 2009 to 77.9% in 2018 (Fig.1).1 This review looks at some of the more recent evidence for the following indications: posterior glenoid deficiency with intact cuff, massive irreparable rotator cuff tears (without glenohumeral arthritis), fracture, tumour, revision surgery, and in the treatment of younger patients.

The decision to undergo RTSA is a multifactorial one taken by the patient in concert with the surgeon. Early in the natural history of the disease, conservative measures such as activity modification, physiotherapy, simple analgesia, and corticosteroid injections may be considered. When the patient’s pain and loss of function have progressed to the point that the risks, cost and inconvenience of undergoing surgery are outweighed by the benefits, surgery should be offered. Clinical indicators that can help in this assessment include pain scores, range of motion and patient-related outcome measures (PROMs).

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