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Stay Out of Trouble in Reverse Shoulder Arthroplasty

February 10, 2018

Contributors: Andrea Arpaia, MD; Davide Blonna, MD; Michael Jean Calò, MD; Filippo Castoldi, MD; Giovanni Ferrero, MD; Lorenzo Mattei, MD; Enrico Bellato, MD; Enrico Bellato, MD

2018 AWARD WINNER This video discusses the key steps we believe surgeons should follow to perform a safe and successful primary reverse shoulder replacement procedure. The first step is to select the appropriate candidate for the procedure and to perform adequate preoperative preparation. CT is fundamental to evaluate glenoid version, possible glenoid bone defects, and the need for patient-specific instrumentation. Proper patient positioning is essential to avoid intraoperative patient shifting and neck stretching and to allow for free range of shoulder motion. Either the deltopectoral or the anterolateral approach can be used; however, the surgeon should be aware of the advantages and disadvantages of both approaches. Retractors should be placed to attain the best possible view of the joint, with caution given to the neurovascular structures. During preparation of the humeral head, the surgeon should consider possible proximal migration of the humerus, the subjective variability of humeral version, and the patient’s range of motion expectations. Glenoid exposure is critical and must be performed meticulously. Proper instruments, long head of the triceps release, posterior capsule release, and eventual revision of the humeral osteotomy allow for an adequate glenoid surface and neck view. Drawing the anatomical axes of the glenoid helps the surgeon during placement of the guidewire in the glenoid, which should be inserted in the center of the neck, slightly inferiorly, and with some degree of inferior tilt. To attain the best possible baseplate fixation, the screws should be directed towards the three columns of the scapular bone. Baseplates with variable-angle locking screws should be considered to freely orientate the screws. The suprascapular nerve must be avoided during posterior screw insertion. Implant stability must be assessed by testing shoulder range of motion and the deltoid and conjoint tendon tension.

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