Prospective cohort of 58 patients treated with the Delta III reverse shoulder prosthesis for painful pseudoparesis from irreparable rotator cuff tears. 17 were primary cases; 41 were revisions of prior shoulder surgery. The study asks whether the implant improves pain and function in both settings, and at what complication cost.
Before the Delta III, rotator cuff arthropathy had no reliable surgical solution: hemiarthroplasty gave partial pain relief but poor function, and conventional total shoulder replacement failed from early glenoid loosening without an intact cuff to offload the component.
This paper established the benchmark outcomes that justify offering reverse shoulder arthroplasty to appropriately selected patients. When you see a patient with pseudoparesis (active elevation <90° with free passive motion), acromiohumeral distance <7 mm, and Goutallier >stage 2 fatty infiltration, this is the data behind the decision to proceed.
Counsel patients that elevation and abduction improve dramatically, but external rotation will likely worsen by about 5°. Also tell revision patients upfront: their pain relief and Constant score will be meaningfully lower than primary cases (58% vs 72%), and their reoperation risk is double.
Scapular notching is nearly universal radiographically — do not mistake its presence for failure. At short-to-medium term, it does not predict clinical outcomes, though long-term implications remain unknown.
Prospective cohort of 58 patients treated with the Delta III reverse shoulder prosthesis for painful pseudoparesis from irreparable rotator cuff tears. 17 were primary cases; 41 were revisions of prior shoulder surgery. The study asks whether the implant improves pain and function in both settings, and at what complication cost.
Before the Delta III, rotator cuff arthropathy had no reliable surgical solution: hemiarthroplasty gave partial pain relief but poor function, and conventional total shoulder replacement failed from early glenoid loosening without an intact cuff to offload the component.
This paper established the benchmark outcomes that justify offering reverse shoulder arthroplasty to appropriately selected patients. When you see a patient with pseudoparesis (active elevation <90° with free passive motion), acromiohumeral distance <7 mm, and Goutallier >stage 2 fatty infiltration, this is the data behind the decision to proceed.
Counsel patients that elevation and abduction improve dramatically, but external rotation will likely worsen by about 5°. Also tell revision patients upfront: their pain relief and Constant score will be meaningfully lower than primary cases (58% vs 72%), and their reoperation risk is double.
Scapular notching is nearly universal radiographically — do not mistake its presence for failure. At short-to-medium term, it does not predict clinical outcomes, though long-term implications remain unknown.