Reverse shoulder replacement for chronic non union of the proximal humerus

The use of the reverse shoulder arthroplasty in the elderly is valuable not only for the treatment of rotator cuff arthropathy but also for the treatment of painful non union of the proximal humerus. My experience has been that open reduction and internal fixation is not a predictable solution in these cases due to the osteoporosis, poor nutrition and blow flow to the bone. This case below illustrates that the reverse total shoulder replacement provides solutions for problems that we did not have a solution before.

I prefer to use large glenospheres for those cases as instability can be a problem

I also prefer to use eccentric glenospheres which minimize the risk of impingement and scapular notching especially when the neck shaft angle of the humeral stem is more than 135 degrees. Those stems bring the humerus closer to the glenoid and can impinge. Impingement can be avoided by implanting a glenosphere with a 2-3 mm of inferior eccentricity.

The preoperative and postoperative images are shown below. This patient is in his 80s.

Dissection can be challenging especially when the proximal humerus is migrated in the axilla where the axillary a. and nerve can be traumatized at the time of surgery. Caution and patience is recommended during the dissection.