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Design Principles of Reverse Arthroplasty

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Textbook of Shoulder Surgery

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Abstract

To restore function in cuff deficient shoulders reverse arthroplasty designs were developed. By reversing the articulation the center of rotation can be placed medially and inferiorly thereby restoring the length of the deltoid muscle. Furthermore, less muscle force is needed to elevate the arm since the lever arm for the deltoid muscle become longer. The first designs failed, but the concept introduced by Grammont, where a large hemisphere are placed on the glenoid side with the center of rotation at the bone-implant interface, has proven to be very successful. The original Grammont type reverse shoulder arthroplasty has a humeral non-anatomical inclination of 155 degrees and a large hemisphere on the glenoid side. This restores deltoid length, actually overtensions it, and improves the biomechanics of the deltoid muscle. Furthermore, more deltoid muscle can be used for abduction. However, impingement between the humeral component and scapula (notching) has been a concern. The original Grammont design has therefore been challenged and modified designs to reduce the risk for notching introduced. Compared to the original Grammont type design, lateralizing the center of rotation, lateralizing the humerus, and changing the inclination angle has been shown to decrease the risk of notching and improve rotation. When the center of rotation is lateralized the load on the glenoid component increases, resulting in a higher risk of glenoid component failure. A less medialized center of rotation decreases the lever arm for the Deltoid muscle compared to the original Grammont concept.

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Authors and Affiliations

  1. Department of Orthopaedics, Capio St Görans Hospital, Stockholm, Sweden

    Anders Ekelund

  2. Lyon, France

    Didier Poncet

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  1. Anders Ekelund
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Correspondence to Anders Ekelund .

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Editors and Affiliations

  1. Wrightington Hospital, Wigan, Lancashire, UK

    Ian A. Trail

  2. Wrightington Hospital, Wigan, Lancashire, UK

    Lennard Funk

  3. Orthopaedic Surgery Department, The James Cook University Hospital, Middlesbrough, North Yorkshire, UK

    Amar Rangan

  4. Trauma & Orthopaedics Department, Countess of Chester Hospital, Chester, Cheshire, UK

    Matthew Nixon

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Ekelund, A., Poncet, D. (2019). Design Principles of Reverse Arthroplasty. In: Trail, I., Funk, L., Rangan, A., Nixon, M. (eds) Textbook of Shoulder Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-70099-1_17

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  • DOI: https://doi.org/10.1007/978-3-319-70099-1_17

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