Reverse Shoulder Replacement in a Chronic Dislocated Shoulder with Massive Cuff Tear

Description

This video transcript is a technical demonstration of a reverse shoulder replacement procedure. The patient presents with rheumatoid arthritis, chronic neglected shoulder dislocation, and an irreparable massive cuff tear. The surgical approach begins at the delta pectoral interval, where the cephalic vein is retracted laterally, and the biceps groove is opened. Following this, the synovial membrane is excised, and a tenotomy of the subscapularis is performed to allow further manipulation of shoulder structures. The capsule adherent to the subscapularis is removed, facilitating its repositioning in the subscapularis fossa. The labrum is systematically excised to expose the glenoid. Afterward, the anatomical neck of the humerus is accessed, and a free-hand cut is made to establish the proper alignment for the reverse shoulder implant. The medullary canal is prepared with reamers, followed by broaching to accommodate the implant size. Glenoid exposure is crucial, achieved using retractors, and the cartilage removal is performed carefully to maintain the integrity of the underlying bone, which is soft in this case. A central pin is placed to guide implantation, and the glenoid baseplate is secured with screws, including a central screw followed by peripheral screws. Subsequently, the glenosphere is attached and secured in position. Finally, trial reductions are implemented, progressing towards the placement of the trial poly and humeral tray. The video provides a detailed step-by-step explanation of each part of the procedure.

DOI: 10.1302/3114-221858

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