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Scientific Articles   |    
Reverse Shoulder Arthroplasty in the Management of Irreparable Rotator Cuff Tears without Arthritis
Kevin L. Harreld, MD1; Brian L. Puskas, MD1; Jaron Andersen, MD1; Mark Frankle, MD1
1 Florida Orthopaedic Institute, 13020 North Telecom Parkway, Tampa, FL 33637. E-mail address for M.A. Frankle: frankle@pol.net
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Based on an original article: J Bone Joint Surg Am. 2010;92:2544-56



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2011 Sep 28;01(02):e12 1-15. doi: 10.2106/JBJS.ST.K.00006
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Extract

Overview
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

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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