This case highlights the value of the reverse shoulder arthroplasty in treating shoulder problems that were very difficult to solve in the past. There are still orthopaedic surgeons who believe that the reverse shoulder replacement is not a "good" implant due to the complications that is associated with. One must take into account that the implant design has improved since the introduction by Paul Grammont and also that the reverse shoulder replacement in the setting of revision surgery is a technically challenging operation that requires a surgeon experienced in revision shoulder surgery. While it is important to be conservative in the indications for surgery on the other hand is also important to be open minded to new ideas and implants and instead of rejecting new ideas rather examine them critically. Of note when Paul Grammont introduced the reverse shoulder replacement he was seen in a negative way by his peers and most of the surgeons at that time though that "reversing the anatomy" of the shoulder was nothing more than an extreme suggestion bound to fail due to the shear forces at the glenoid. The following case demonstrates the value of reverse shoulder replacement in salvaging difficult problems of the shoulder.
This is a 75 y/o F with a 35 year old malunion of the proximal humerus and shoulder active forward elevation (FE) to 25 degrees. She was neurovascularly intact at presentation with a functioning deltoid muscle and significant pain with active FE. She underwent a reconstruction to a reverse and her active FE was to 100 degrees at 4 months without pain. The technical tip for his operation was the "in situ" humeral cut that allowed dislocation of the shoulder. The insitu humeral cut is always conservative to preserve bone stock at the proximal humerus and if needed is revised to a more aggressive cut after the dislocation of the shoulder.
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| Preop AP and Grashey view (unable to obtain axillary due to stiffness) |
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| Preop CT scan for templating |
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| Intraop images with trial components in place |
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| Immediate postoperative image |
