This multicenter study reviewed 80 Grammont inverted (reverse) shoulder arthroplasties in patients with glenohumeral osteoarthritis and irreparable massive cuff tears. It asks whether an implant that makes the deltoid drive a cuff-deficient shoulder restores function at mid-term follow-up. It also introduces classifications for glenoid erosion and scapular notching.
When you see an elderly patient with pseudoparalysis, an irreparable massive cuff tear, and glenohumeral arthritis, the cuff is gone and the deltoid needs a mechanical advantage to elevate the arm. The Grammont design provides that by lowering and medializing the center of rotation, lengthening the deltoid moment arm and converting destabilizing glenoid shear into compression.
That mental model explains both the win (elevation to 138° vs the ~112° ceiling of hemiarthroplasty) and the trade-offs you must counsel on: scapular notching, glenoid loosening, and glenosphere dissociation.
Two pearls to carry into practice. First, assess teres minor preoperatively, because it is the external rotator that determines whether the patient regains functional rotation. Second, in E2 and E3 glenoids, seat the baseplate low with a slight inferior tilt to limit notching.
The sharp survivorship drop after seven years with these early implants is the reason the authors restrict this to elderly patients with adequate glenoid bone stock.
Inverted TSA Massive Cuff Rupture 2
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This multicenter study reviewed 80 Grammont inverted (reverse) shoulder arthroplasties in patients with glenohumeral osteoarthritis and irreparable massive cuff tears. It asks whether an implant that makes the deltoid drive a cuff-deficient shoulder restores function at mid-term follow-up. It also introduces classifications for glenoid erosion and scapular notching.
When you see an elderly patient with pseudoparalysis, an irreparable massive cuff tear, and glenohumeral arthritis, the cuff is gone and the deltoid needs a mechanical advantage to elevate the arm. The Grammont design provides that by lowering and medializing the center of rotation, lengthening the deltoid moment arm and converting destabilizing glenoid shear into compression.
That mental model explains both the win (elevation to 138° vs the ~112° ceiling of hemiarthroplasty) and the trade-offs you must counsel on: scapular notching, glenoid loosening, and glenosphere dissociation.
Two pearls to carry into practice. First, assess teres minor preoperatively, because it is the external rotator that determines whether the patient regains functional rotation. Second, in E2 and E3 glenoids, seat the baseplate low with a slight inferior tilt to limit notching.
The sharp survivorship drop after seven years with these early implants is the reason the authors restrict this to elderly patients with adequate glenoid bone stock.