Introduction. Reverse shoulder replacement is a surgical option for cuff tear arthropathy. However scapular notching is a concern. Newer designs of glenospheres are available to reduce scapular notching. Eccentric glenosphere with a lowered centre of rotation have been shown to improve range of adduction in vitro. We hypothesize that the eccentric glenosphere improve clinical outcomes and reduce scapular notching. Method. This is an ongoing randomized controlled double blind prospective clinical trial. Patients 70 years or older at North Shore hospital who have a diagnosis of cuff tear arthropathy and require surgery were consented for this study. Patients were allocated a concentric or eccentric 36 mm glenosphere intraoperatively, using a computer generated randomization contained in a sealed envelope. The surgical technique and post operative rehabilitation were standardized. Patients were followed up by a research nurse and postoperative radiographs were also taken at regular intervals. Clinical assessment include a visual analogue pain score, subjective shoulder rating, American Shoulder and Elbow Society Score, and Oxford shoulder score. Complications were checked for and radiographs were assessed for scapular notching. Results. There were 23 patients in the concentric and 24 patients in the eccentric glenosphere group. Average age and duration of follow up were comparable. There was no statistical significant difference but there was a trend towards better functional outcome and better range of motion in the eccentric glenosphere group. There was no scapular notching in the eccentric and three cases of scapular notching in the concentric glenosphere group. Conclusions. Reverse shoulder replacement significantly improve pain, function and range of motion in patients with cuff tear arthropathy. Eccentric glenosphere prevents scapular notching in the SMR reverse prosthesis

We used an inverted shoulder arthroplasty in 43 consecutive patients with a mean age of 78 years (65 to 97) who had sustained a three- or four-part fracture of the upper humerus. All except two were reviewed with a mean follow-up of 22 months (6 to 58). The clinical outcome was satisfactory with a mean active anterior elevation of 97° (35° to 160°) and a mean active external rotation in abduction of 30° (0° to 80°). The mean Constant and the mean modified Constant scores were respectively 44 (16 to 69) and 66% (25% to 97%). Complications included three patients with reflex sympathetic dystrophy, five with neurological complications, most of which resolved, and one with an anterior dislocation. Radiography showed peri-prosthetic calcification in 36 patients (90%), displacement of the tuberosities in 19 (53%) and a scapular notch in ten (25%). Compared with conventional hemiarthroplasty, satisfactory mobility was obtained despite frequent migration of the tuberosities. However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly

This clinical study analyzes the long-term outcomes and potential complications of the Grammont's reverse prosthesis in case of trauma in elderly population. Between January 1993 and May 2010, thirty-seven consecutive patients with 26 three- and four-part fractures and 11 fracture-dislocations, mean age 75 (58 to 92) were evaluated with a mean follow-up of 7.3 years. Eight complications occurred: 2 complex sympathetic dystrophies, 3 dislocations, 2 deep infections and one aseptic loosening of the base-plate leading to 3 re-operations and 2 prosthesis revisions. The mean Constant's score dropped from 55 at two year follow-up to 52 (20 to 84) at last revision because of an augmentation of the pain and a diminution of the strength which represented 67% of the mean score for the injured side. Mean modified Constant's score was 68. Only 58% were satisfied or very satisfied because of poor internal and external rotations avoiding nourishment with utensils, dressing and personal hygiene when the dominant side was involved. Two complete glenoid borders, fourteen stable inferior spurs, twenty-one inferior scapular notches including ten of them with medial proximal humeral bone loss or radio lucent lines between the bone and the cement were observed. Notches were more important in size when the follow-up was longer. 62% of the patients had worrying images. The crossing of the clinical and radiological data showed a degradation of the mean Constant's score (41) for pain and strength in cases of notches with troubling proximal humeral images. In spite of only one case of aseptic loosening at 12 year follow-up, results are disappointing and complications and revisions rates important. The functional result is never equal to the pre-broken state. New developments in design, bearing surfaces and surgical technique and a more long term results will refine the role of the reverse concept for fracture