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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2009 February;60(1):61-74
Indications for the reverse prosthesis
McFarland E. G., Srikumaran U., Freehill M. T., Pannirselvam V., Petersen S. A.
Division of Shoulder Surgery Department of Orthopaedic Surgery The Johns Hopkins University, Baltimore, MD, USA
The reverse prosthesis was originally designed for patients with large rotator cuff tears associated with arthritis. The purpose of the prosthesis was to medialize the joint reaction force to enhance the lever arm of the deltoid, and thereby enable the muscle to lift the arm. The reverse prosthesis has been successful for patients with cuff tear arthropathy, but its use for other indications has not received adequate attention in the medical literature. Those indications include patients with rotator cuff tears who have lost motion but do not have arthritis (i.e., pseudoparalysis without pain), rheumatoid arthritis, failed total shoulder or hemiarthroplasty secondary to rotator cuff tears or instability, degenerative arthritis with rotator cuff tears, chronic and unreduced shoulder instability, proximal humerus fractures, and tumors around the shoulder. The reverse prosthesis has increased the number of shoulders that might not be salvaged otherwise, but the results of its use for indications other than cuff tear arthropathy are less well-known. Although the reverse prosthesis has proved to be effective for pain relief for most indications, its role in the treatment of these conditions has yet to be defined because of its associated high complication rate. The goals of this article are to present the various indications for the reverse prosthesis and to summarize the current published outcomes of its use for those indications.