Gleno-humeral primary osteoarthritis is a progressive disorder characterized by damage to the articular cartilage of humeral head and/or glenoid. It can lead to debilitating functional limitations, compromising the individual’s quality of life leading to a signifcant socio-economic burden on the family and society. Shoulder replacement is the ideal solution for such patients. Reverse Shoulder replacement has emerged as the preferred technique for dealing with neglected long standing cases of arthritis or tendon damage or fracture situations or complications arising out of previous treatments or neglect, owing to better outcome and lower failure rate than conventional anatomical total shoulder replacement. More sophisticated implants, designs, techniques, coupled with better understanding of the shoulder biomechanics has contributed to the popularity of the procedure. Over conventional shoulder replacement, Reverse Shoulder replacement functions in a way that it does not require the stabilizing effect of rotator cuff musculature, which are so essential for conventional replacement to function.
Reverse Shoulder Arthroplasty has proven to be advantageous in the following conditions:
The Medanta Institute of Musculoskeletal Disorders and Orthopedics has a Dedicated Shoulder and Upper Limb Unit which provides world-class care in arthroscopy and joint replacements of the upper limb. The team has an experience of over 3500 shoulder surgeries and over 200 shoulder replacement surgeries.
We present a case of complex primary osteoarthritis of the shoulder where a conventional anatomical shoulder replacement would have failed because of defciency in the socket (glenoid) of the shoulder. A 65-year-old male reported to Medanta with two-year history of right side shoulder pain which had progressed over time and increased in intensity. He had diffculty moving his right shoulder and performing activities of daily living. He had been misdiagnosed as frozen shoulder and managed with analgesics and intra articular steroid injections elsewhere. The patient was experiencing pain even at rest; loading of the joint was also painful. He was a known hypertensive and had undergone knee replacement in the past.
The patient presented with the fndings of restricted range of motion with internal rotation contracture of 30 degrees which was limiting him from even accessing his back pocket. External rotation was not possible due to internal rotation contracture, abduction was 70 degrees, and forward fiexion was 100 degrees. The strength of muscles could not be tested as loading the arm was extremely painful. X-rays revealed primary osteoarthritis of the shoulder with Walch B2 biconcave glenoid, erosion of the posterior glenoid with increased retroversion of humerus. The head of the humerus was locked posteriorly
True AP view of shoulder showing Glenohumeral arthritis
axillary view of the shoulder showing glenoid bone loss posteriorly, typically a Biconcave glenoid
CT scan was done to measure the exact bone loss on axial cuts, and get an estimate of wedge bone graft required to compensate for the glenoid defect to correct the native glenoid version.
Axial CT cut showing arthritis and bone loss of glenoid
Pre-anaesthetic checkup of the patient was done and he was planned for Complex Reverse Shoulder Arthroplasty. The surgery was performed on the patient with biological restoration of the offset using a wedge bone graft from the humeral head.
True AP view post operative
Axillary view post operative
The aim of Reverse Shoulder Arthroplasty is to restore painless functional joint which was achieved in this case despite the surgery being technically complex and challenging. 1.5 years post-op, the patient is doing well with stable, strong and pain-free shoulder.
Post-op patient images showing functional range of motion indicating independence in performing activities of daily living.