Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations.


Journal Article (Review)

Superior tilt of the baseplate component in reverse total shoulder arthroplasty leads to tensile baseplate forces and may be a contributor to early loosening. The risk factors for this implant malposition include inadequate exposure through a superior approach and superior glenoid bone deficiency that obscures the native glenoid tilt. Here we review our preoperative evaluation and surgical management strategies to avoid superior tilt. Adequate exposure with a superior approach can be achieved but requires not just proper surgical technique but also careful patient selection. We propose that the superior approach be considered only for acute proximal humerus fractures or in patients when the following criteria are met: no prior open surgery on the shoulder; more than 30° of passive external rotation at 0° of abduction; no medial humeral osteophytes; and any superior migration must be reducible with a sulcus test during examination under anesthesia. Avoiding superior tilt when there is significant superior glenoid erosion can be accomplished with humeral head autograft, most easily performed through a deltopectoral approach. Preoperative templating is critical to determine proper graft thickness, inclination, reaming depth, and harvest technique.

Full Text

Cited Authors

  • Laver, L; Garrigues, GE

Published Date

  • October 2014

Published In

Volume / Issue

  • 23 / 10

Start / End Page

  • 1582 - 1590

PubMed ID

  • 25220202

Pubmed Central ID

  • 25220202

Electronic International Standard Serial Number (EISSN)

  • 1532-6500

International Standard Serial Number (ISSN)

  • 1058-2746

Digital Object Identifier (DOI)

  • 10.1016/j.jse.2014.06.029


  • eng