Frankle (2005) — The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. a Minimum Two-Year Follow-Up Study of Sixty Patients.

·J Bone Joint Surg Am·2005·773 citations·Shoulder & Elbow

Retrospective cohort study of 60 patients with glenohumeral arthritis and irreparable rotator cuff tears treated with the Reverse Shoulder Prosthesis (RSP). Minimum 2-year follow-up; evaluates whether RSP delivers meaningful pain relief and functional gains when no functional cuff remains. This 2006 publication is the surgical technique companion to the 2005 JBJS index series, adding device modifications and a glenosphere selection algorithm.

Study Snapshot

Design

Retrospective cohort

Setting: Florida Orthopaedic Institute, Tampa, Florida

Funding: Industry (Encore Medical)

Objective

Whether reverse shoulder arthroplasty provides pain relief and functional improvement in glenohumeral arthritis with irreparable rotator cuff deficiency.

Outcome(s)

ASES score, VAS pain/function, shoulder range of motion; minimum 2-year follow-up

Subjects

60 patients (60 shoulders)

Inclusion

Rotator cuff deficiency with glenohumeral arthritis
Treated with Reverse Shoulder Prosthesis
Minimum 2-year follow-up

Follow-up

Minimum 2 years (mean 33 months)

Statistics

p-value reporting

Key Findings

ASES total score nearly doubled from 34.3 to 68.2 (p < 0.0001) at mean 33-month follow-up, with gains in both pain (18.2 to 38.7) and function (16.1 to 29.4) subscores. The deltoid alone can drive clinically meaningful improvement even with zero functional rotator cuff.
Forward flexion nearly doubled (55° to 105°) and abduction more than doubled (41° to 102°), both p < 0.0001. These motion gains validate the core premise of RSA: shifting the center of rotation lets the deltoid substitute for the absent cuff.
68% of patients (41/60) rated outcomes good or excellent; only 3 of 60 were dissatisfied. Patient satisfaction closely tracks objective motion gains.
Complication rate was 17% (13 complications in 10 patients) and revision rate was 12% (7 patients). Of 8 failures, 5 were revised to another RSP and 2 were converted to hemiarthroplasty for deep infection. These numbers anchor modern informed-consent discussions for RSA.
A glenosphere selection algorithm is introduced based on bone quality and desired center of rotation:
–Good bone quality: lateral center of rotation (up to 10 mm from glenoid with 32 mm neutral glenosphere) — maximizes residual cuff tension and range of motion
–Poor bone quality: medial center of rotation (0 mm from glenoid with 40 mm -4 mm offset glenosphere). Minimizes baseplate stress and protects fixation
Three technique modifications were introduced to reduce mechanical failure:
–5.0 mm locking screws replacing 3.5 mm nonlocking screws (prevents baseplate toggling)
–10°-15° inferior baseplate tilt* (minimizes shear forces, improves compression uniformity)
–Medialization of center of rotation for poor glenoid bone quality
Absolute contraindications to RSA are defined and include nonfunctional deltoid, active infection, excessive glenoid bone loss, severe neurologic conditions (Parkinson disease, Charcot joints, syringomyelia), refusal to modify postoperative activities, and metal allergy. A nonfunctional deltoid is the most critical. Without it, RSA cannot work.

Board PearlReverse shoulder arthroplasty nearly doubles forward flexion and achieves 68% good-to-excellent outcomes in cuff tear arthropathy — the deltoid alone restores elevation.

Clinical Relevance

Cuff tear arthropathy — pseudoparalytic shoulder elevation combined with glenohumeral arthritis from an irreparable massive cuff tear. Had no reliable surgical solution before RSA. Hemiarthroplasty and resection arthroplasty provided pain relief but rarely restored active elevation.

When you see a patient with pseudoparalysis and radiographic cuff tear arthropathy, RSA is first-line surgical treatment. Expect roughly a doubling of forward flexion and a 68% good-to-excellent satisfaction rate at 2 years. Counsel patients on a 17% complication rate and 12% revision rate. These numbers come directly from this landmark series.

Before consenting a patient, confirm the deltoid is functional. A nonfunctional deltoid is an absolute contraindication; RSA works by recruiting the deltoid to replace the absent cuff, and without it the construct fails.

The glenosphere selection algorithm introduced here is the origin point of the ongoing medialized-vs-lateralized center-of-rotation debate that now dominates the RSA implant literature. The clinical rule: good bone gets a lateral glenosphere to maximize function; poor bone gets a medial glenosphere to protect fixation.

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. a Minimum Two-Year Follow-Up Study of Sixty Patients.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. a Minimum Two-Year Follow-Up Study of Sixty Patients.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. a Minimum Two-Year Follow-Up Study of Sixty Patients.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. a Minimum Two-Year Follow-Up Study of Sixty Patients.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles