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Clin Shoulder Elb > Volume 14(1); 2011 > Article
Clinics in Shoulder and Elbow 2011;14(1):105-110.
DOI:    Published online June 30, 2011.
Reverse Total Shoulder Arthroplasty: Where we are? "Principles"
Kyu Cheol Noh, Il Woo Suh
Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
견관절 역행성 인공관절 치환술의 원칙
한림대학교 강남성심병원 정형외과학교실
The purpose of this article is to identify and understand the complications of RTSA and to review the current methods of preventing and treating this malady. MATERIALS AND METHODS: Previous constrained prostheses (ball-and-socket or reverse ball-and-socket designs) have failed because their center of rotation remained lateral to the scapula, which has limited of the motion of the prostheses and produced excessive torque on the glenoid component, and this leads to early loosening. The Grammont reverse prosthesis imposes a new biomechanical environment for the deltoid muscle to act, thus allowing it to compensate for the deficient rotator cuff muscles.
The clinical experience does live up to the lofty biomechanical concept and expectations: the reverse prosthesis restores active elevation above 90degrees in patients with a cuff-deficient shoulder. However, external rotation often remains limited and particularly in patients with an absent or fat-infiltrated teres minor. Internal rotation is also rarely restored after a reverse prosthesis. Failure to restore sufficient tension in the deltoid may result in prosthetic instability.
Finally, surgeons must be aware that the results are less predictable and the complication/revision rates are higher in revision surgery than that in the first surgery. A standardized monitoring tool that has clear definitions and assessment instructions is surely needed to document and then prevent complications after revision surgery.
Key Words: Reverse total shoulder arthroplasty; Cuff tear arthropathy


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