This review covers the indications, perioperative considerations, and complications of reverse total shoulder arthroplasty. It walks through the Grammont biomechanical rationale and how expanded indications and design changes affect complication profiles. Complications are organized by intraoperative and postoperative categories with management strategies.
Understand the Grammont principle first: a massive cuff tear destroys the fulcrum and lets the head ride superiorly, so medializing and lowering the center of rotation lets a tensioned deltoid elevate the arm.
That same medialization is the tradeoff that drives scapular notching, the most common complication. Prevent it with inferior glenosphere positioning and overhang, a lateralized center of rotation, and reduced neck-shaft angle. Risk-stratify by setting. Revision cases carry higher instability and infection (5.8% vs 2.9%), and patients under 60 fail more often despite good early function.
Know the two named classifications cold: Nérot for scapular notching (Grade 4 = glenoid loosening) and Levy for acromial stress fractures by deltoid origin involvement. When a prosthesis fails within 2 years, think infection before you think mechanics.
This review covers the indications, perioperative considerations, and complications of reverse total shoulder arthroplasty. It walks through the Grammont biomechanical rationale and how expanded indications and design changes affect complication profiles. Complications are organized by intraoperative and postoperative categories with management strategies.
Understand the Grammont principle first: a massive cuff tear destroys the fulcrum and lets the head ride superiorly, so medializing and lowering the center of rotation lets a tensioned deltoid elevate the arm.
That same medialization is the tradeoff that drives scapular notching, the most common complication. Prevent it with inferior glenosphere positioning and overhang, a lateralized center of rotation, and reduced neck-shaft angle. Risk-stratify by setting. Revision cases carry higher instability and infection (5.8% vs 2.9%), and patients under 60 fail more often despite good early function.
Know the two named classifications cold: Nérot for scapular notching (Grade 4 = glenoid loosening) and Levy for acromial stress fractures by deltoid origin involvement. When a prosthesis fails within 2 years, think infection before you think mechanics.