Reverse Shoulder Arthroplasty: What, Why, and How

A roundtable discussion with members of the ASES

The number of shoulder arthroplasty procedures performed each year in the United States is increasing rapidly; estimates range from 55,000 to 80,000. Of these, about half are “reverse” shoulder arthroplasties (RSAs), in which the normal anatomy of the shoulder is switched. Rather than having the ball (top of the humerus) fit into the cup (glenoid socket) (Fig. 1), the glenoid is fitted with a metal ball, and the cup is fixed to the upper end of the humerus (Fig. 2).

This reverse approach was developed by the French surgeon Paul M. Grammont, MD, and approved in the United States by the U.S. Food and Drug Administration in 2004. Since then, it has become the procedure of choice when the patient has massive rotator cuff arthropathy and, as surgeons become more familiar with the approach and implant designs are refined, indications for its use are continuing to expand.

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