Reverse Shoulder Arthroplasty in the Management of Irreparable Rotator Cuff Tears without Arthritis.

Introduction: The ability to provide reliable outcomes in treatment of patients with degenerative rotator cuff tears has become increasingly complicated, as a result of more advanced disease and the increased array of treatment choices.

Step 1 Preoperative Planning: Develop and communicate with a consistent team of interdisciplinary physicians both preoperatively and postoperatively; utilize advanced imaging modalities to evaluate muscle atrophy as well as glenoid and humeral bone stock.

Step 2 Patient Positioning: Place the patient in a beach-chair position, check the abdominal strap, and position yourself facing the axilla.

Step 3 Surgical Approach: Develop the subdeltoid and subacromial spaces and take care to avoid vigorous over-retraction of the deltoid.

Step 4 Humeral Exposure And Preparation: Perform the head cut utilizing the 135° resection guide, broach the humerus, and ream the humeral socket.

Step 5 Glenoid Exposure And Preparation Glenosphere Insertion: Ream the inferior surface to bleeding subchondral bone; bleeding subchondral bone on the inferior 50% of the prepared glenoid surface indicates a sufficient depth.

Step 6 Final Humeral Preparation: At final reaming, the edge of the reamer should sit flush with the cut surface of the humerus.

Step 7 Trialing: Proper soft-tissue balance is frequently achieved by positioning the humeral component so that the rim of the socket lies just above the humeral osteotomy site at the anatomic neck.

Step 8 Component Implantation And Closure: When cementing the humeral component, the socket should match the reamed proximal part of the humerus.

Results: Initially, reverse shoulder arthroplasty was primarily used to treat osteoarthritis of the glenohumeral joint resulting from chronic rotator cuff deficiency or for true rotator cuff tear arthropathy.

What To Watch For: Indications Contraindications Pitfalls & Challenges.