Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty

Dear Colleagues,

Reverse shoulder arthroplasty (RSA) has become the mainstay of shoulder arthroplasty in the 21st century and is considered the most important breakthrough and innovation in upper limb arthroplasty in the last 50 years.

Surgical planning for RSA is critical to achieving optimal implant positioning. Initially, basic templating used radiographs or 2D CT scans as a reference; this shifted to a patient-specific implantation (PSI) approach with the introduction of 3D software. More recently, CT-based navigation has also been developed, followed by the advent of mixed and augmented reality—bringing the surgical plan into the field of view of the operating surgeon. Surgery can be guided by augmented-reality-based navigation and optimized using robotic reaming and saw cuts. However, in times of limited resources and tight budgets, questions arise about whether these developments are cost-effective for clinical improvements, in terms of “time to return to activities of daily living” and long-term outcomes. Are these improvements measurable? Additionally, in which cases should we be using this technology?

Artificial intelligence (AI) has become more readily available and can help us find the best implant combination and position. AI can learn from the previous actions of experienced surgeons and deep learn “the best way” to implant for a given case.

In terms of planning rotator cuff tendon and deltoid tension, the integration of muscle volume and fatty infiltration and the integration of scapulothoracic posture, motion and kinematics, we are only in the early stages of an exciting field of research that has been overlooked for a long time due to a lack of valid assessment tools.

The biomechanics of RSA have shifted from Grammont’s design, with a medialized center of rotation and a long moment arm, to the modern lateralized RSA. Lateralized RSA can be performed in different ways, with lateralization of the glenoid, humerus or combined, and with different amounts of distalization, lengths of moment arms and neck shaft angles. Some developers speak of “biomechanical” RSA lateralization (longer moment arms) and “anatomic” RSA lateralization, with closer to normal muscle length with better contractility.

There are still many questions to be answered, and the fascinating journey of RSA lies ahead of us. The aim of this Special Issue is to provide an overview of the new “tools” available on the market and present advances in soft tissue and scapulothoracic integration, as well as biomechanics and clinical results.

We are looking forward to receiving your contributions to advance our understanding and knowledge in these fields.

Dr. Stefan Bauer
Dr. Allan W. Wang
Dr. William G. Blakeney
Dr. Jean-David Werthel
Guest Editors

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