Reverse Total Shoulder Arthroplasty: Technique, Decision-Making and Exposure Tips

The goal of this review is to introduce surgical decision-making pearls for reverse shoulder arthroplasty and describe optimization of surgical exposure for reverse shoulder arthroplasty. While the technology of reverse shoulder replacement and the associated prosthetic options have expanded, the principles involved in successfully exposing the humerus and glenoid in arthroplasty remain the same. Reverse shoulder replacement should be considered in arthroplasty situations with rotator cuff disease, deformity, bone loss, and instability as part of the diagnosis. Optimal exposure in reverse shoulder arthroplasty can be obtained by (1) releasing deltoid adhesions, (2) removal of humeral osteophytes, (3) generous humeral head cuts, (4) thorough humeral and glenoid capsular release and (5) optimal glenoid retractor placement. Neuromuscular paralysis can also aid glenoid exposure.