Reverse Shoulder Prosthesis® (RSP®)

Reverse Shoulder Prosthesis
Reverse Shoulder Prosthesis
Surgical

Reverse® Shoulder Prosthesis (RSP®)

Reverse® Shoulder Prosthesis
A forward-thinking reverse

Center of Rotation
The Reverse Shoulder Prosthesis (RSP®) was the first reverse shoulder design to successfully incorporate a center of rotation (COR) lateral to the glenoid.

Humeral Neck-Shaft Angle

The RSP system features an anatomic humeral neck-shaft angle. Biomechanical testing has shown that having a humeral neck-shaft angle in the range of normal anatomy reduces the potential for inferior scapular notching.1

1Gutierrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am 2008;90:2606-15.

Enhanced Fixation

For successful bony ingrowth, a stable interface between the bone and the prosthetic device is required during initial healing. The design of the RSP baseplate provides 2000N of compression between the prosthesis-bone interface, providing stable initial fixation as well as ideal conditions for bony ingrowth for long-term fixation.

Versatility for Complex Anatomy

A great deal of variability can be experienced in rotator-cuff-deficient shoulders. The RSP system offers unmatched versatility, in size and offset, of glenospheres to manage complex anatomy and surgical outcomes.

Proven Results

The RSP is one of the most well-published reverse shoulders on the market with over forty peer reviewed journal publications.
 

  • Features & Benefits
  • Clinical Results
  • Biomechanical Evaluation
  • Design Surgeon
  • Links
  • References

Humeral Stem

Positioned approximately 12mm below the resected humeral neck osteotomy to ensure that the humeral socket is surrounded by proximal bone support for strength, stability and fixation. 

  • Anatomical-shaped proximal body
  • Cylindrical-shaped distal segment with cement flutes
  • Cemented application only
  • Primary stem: 6 x 101mm, 7 x 105mm, 8 x 109mm, 10mm x 116mm, and 12mm x 124 mm
  • Revision sizes: 6mm, 8mm, 10mm, and 12mm in one length of 175mm

Humeral Socket

Stabilizes the superior and medial pulling forces of the deltoid muscle to restore joint mobility and minimize the risk of bone erosion caused by impingement of the humeral socket against the inferior aspect of the glenoid. 

  • Morse taper fixation to the humeral stem
  • Shell sizes: neutral, +4mm offset, and +8mm offset
  • 18 different sizing configurations
  • Insert sizes: 32mm, 36mm, and 40mm in both standard and semi
  • Titanium alloy constrained option

Glenoid Head

Delivers a force of resistance against humeral socket/glenoid head combination to prevent superior escape of the humerus for long-term stability and wear characteristics.

  • Reverse Morse taper fixation to the glenoid baseplate
  • Sizes: 32mm, 36mm, and 40mm available in neutral or -4mm offset
  • 3.5mm titanium alloy retaining screw mates into glenoid head for additional security

Glenoid Baseplate

Centralized 6.5mm cancellous bone screw with four peripheral 5.0mm locking or 3.5mm non-locking cortical bone screws deliver outstanding fixation and long-term stability.

  • Hydroxyapatite coating plasma sprayed over 3DMatrix® porous coating
  • 5.0mm locking cortical bone screws for perpendicular placement
  • 3.5mm non-locking cortical bone screws for angled placement in any direction up to 12 degrees
  • 26mm diameter baseplate in one length of 30mm

Clinical Challenge
Patients presenting with an irreparable, rotator cuff deficient shoulder joint with severe arthropathy typically show evidence of an upward displacement of the humeral head with respect to the glenoid and a loss of glenohumeral joint space. Unfortunately, the functional outcomes using conventional surgical methods are severely limited and typically fail.

Clinical Solution
The Reverse® Shoulder Prosthesis is a semiconstrained design concept that reverses the shoulder anatomy by lateralizing the shoulder joint to effectively resist the superior pull of the deltoid muscle and optimize soft tissue balancing.

Indications

  • Grossly rotator cuff deficient shoulder joint with severe arthopathy;
  • A previously failed joint replacement with a grossly rotator cuff deficient shoulder joint;
  • Evidence of upward displacement of the humeral head with respect to the glenoid;
  • Loss of glenohumeral joint space
     

Biomechanical Evaluation of the Reverse Shoulder
 

Background

  • In patients with rotator cuff arthropathy, a "reverse" shoulder prosthesis resists glenohumeral subluxation and offers the potential for improved function.
  • Premature mechanical failure due to loosening of the glenoid component is a concern with these devices, especially when used in revision shoulder arthroplasty and in patients with less-than-optimal bone stock, as some reverse shoulder prosthesis have increased lateral offset at the glenohumeral articulation with potentially greater loads transferred to the bone-prosthesis interface.
  • The potential clinical advantages for using an increased offset reverse shoulder prosthesis, such as enhanced stability and function, can only be realized if satisfactory glenoid component fixation is achieved.

In-Vitro Study

  • In-vitro study evaluated initial glenoid component fixation of 2 uncemented "reverse" prostheses during physiologic loading to determine the relationship among lateral offset of the glenosphere, fixation method, and motion.

Results

  • Both lateral offset and peripheral screw type affected the magnitude of baseplate motion.
  • Baseplate motion for Delta III components and Reverse® Shoulder Prosthesis components fixed with 5.0mm captured screws were below the 150 μm of motion generally accepted as the threshold for bone ingrowth.
  • Stable fixation was achieved for the Reverse Shoulder Shoulder Prosthesis neutral components despite a substantially (69%) greater moment at the baseplate-foam interface compared with the Delta III.

Herman M, Frankle M, Vasey M, Banks S. Intial Glenoid Component Fixation in “Reverse” Total Shoudler Arthroplasty: A Biomechanical Evalutation. Journal Shoulder Elbow Surgery. 2005 Jan/Feb; 14(15): 1625-1675

 

Consulting Shoulder Design Surgeon - Mark Frankle, M.D.

One of DJO Surgical’s leading and most influential key design surgeons is Mark A. Frankle, M.D. as he developed the Reverse® Shoulder Prosthesis and is instrumental in the continued development of the system.  

Dr. Mark A. Frankle has been with Florida Orthopaedic Institute, Tampa, Florida, since 1991. He attended Rush University College of Medicine after completing three years of undergraduate studies at Grinnell College in Iowa. Dr. Frankle completed his residency training at the University of South Florida. After residency, he completed an orthopedic pathology and orthopedic implants fellowship at Rush-Presbyterian St. Lukes Hospital. He then completed a reconstructive technique research fellowship program at the prestigious AO/ASIF Prosthetic/Implant Research and Development Complex in Davos, Switzerland. Dr. Frankle then completed an adult reconstructive surgical fellowship at the Mayo Clinic in Rochester, Minnesota.

Dr. Frankle serves as the Director of the Biomechanical Shoulder and Elbow Research Lab at the University of South Florida College of Engineering and is the Director of the annual course, “Current Concepts in Shoulder and Elbow Surgery.” He has published numerous articles in professional journals and maintains ongoing research projects, presenting his work annually at various professional conferences. Dr. Frankle has designed implants and instrumentation used in shoulder replacement for several different orthopedic companies. Dr. Frankle received the prestigious Charles S. Neer Award for Basic Science from the American Academy of Orthopaedic Surgeons. Dr. Frankle is board-certified by the American Board of Orthopaedic Surgery and a member of the American Shoulder and Elbow Society.

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Published Articles
C ML Werner, P A Steinmann, M. Gilbart and C. Gerber. Treatment of Painful Pseudoparesis Due to Irreparable Rotator Cuff Dysfunction with the Delta III Reverse-Ball-and-Socket Total Shoulder Prosthesis. J Bone Joint Surq Am. 2005; 87:1476-1486.

Management of Irreparable Rotator Cuff Tears and Glenohumeral Arthritis By Laurence Laudicina, MD; Robert D'Ambrosia, MD ORTHOPEDICS 2005; 28:382.
View article at orthosupersite.com

Harman M, Frankle M, Vasey M, Banks S. Intial Glenoid Component Fixation in “Reverse” Total Shoudler Arthroplasty: A Biomechanical Evalutation. Journal Shoulder Elbow Surgery. 2005 Jan/Feb; 14(15): 1625-1675.

References

Cuff D, Clark, R, Frankle MA. Reverse Shoulder Arthroplasty for the Treatment of Rotator Cuff Deficiency: A Concise Follow Up, at a Minimum of Five Years, of a Previous Report. . J Bone Joint Surg [Am], In press.

Andersen JA, Williams CD, Cain R, Mighell MA, Frankle M. Surgically Treated Humeral Shaft Fractures Following Shoulder Arthroplasty. J Bone Joint Surg [Am], In press.

Willis M, Walker M, Frankle M. Reverse Total Shoulder Arthroplasty. AAOS Monograph on Total Shoulder Arthroplasty. Sanchez-Sotolo J, Ed. May 2012 ISBN/ISSN: 9780892038565.

Virani NA, Cabezas A, Gutiérrez S, Santoni BG, Otto R, Frankle M. Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion. J Shoulder Elbow Surg. 2012 May 22. [Epub ahead of print]

Affonso J, Nicholson GP, Frankle MA, Walch G, Gerber C, Garzon-Muvdi J, McFarland EG. Complications of the reverse prosthesis: prevention and treatment. Instr Course Lect. 2012;61:157-68.

Willis M, Min W, Brooks J, Mulieri P, Walker M, Pupello D, Frankle M. Proximal humeral malunion treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg (2012) 21, 507-513.

Walker M, Willis M, Brooks J, Pupello D, Mulieri P, Frankle M. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. (2012) 21, 514-522.

Zavala J, Clark J, Kissenberth M, Tolan S, Hawkins R.  Management of deep infection after reverse total shoulder arthroplasty: a case series.  J Shoulder Elbow Surg. 2011; Nov 18 [Epub ahead of print]

Clark J, Ritchie J, Song F, Kissenberth M, Tolan S, Hart N, Hawkins R. Complication rates, dislocation, pain and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis.  J Shoulder Elbow Surg.  2012 Jan;21(1):26-41.  [Epub 2011 Jul 31]

Kwon YW, Pinto VJ, Yoon J, Frankle MA, Dunning PE, Sheikhzadeh A. Kinematic analysis of dynamic shoulder motion in patients with reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2012 Sep;21(9):1184-90.

Harreld K, Puskas B, Frankle M. Massive rotator cuff tears without arthropathy: When to consider reverse shoulder arthroplasty. J Bone Joint Surg Am. 2011;93:973-984.

Cheung EV, Willis M,  Walker M, Clark R, Frankle M. Complications in reverse shoulder arthroplasty.  JAAOS.  2011;19:7.

Walker M, Willis M, Frankle M. How does reverse shoulder arthroplasty work? CORR. 2011 Sep;469(9):2440-51 . 51.

Gutiérrez S, Walker M, Willis M, Pupello DR, Frankle MA. Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty.  J Shoulder Elbow Surg. 2011 Jul;20(5):732-9.

Cuff D, Levy JC, Gutiérrez S, Frankle MA. Torsional stability of modular and non-modular reverse shoulder humeral components in a proximal humeral bone loss model. J Shoulder Elbow Surg. 2011 Jun;20(4):646-51.

Mulieri PJ, Dunning PE, Klein SM, Pupello DR, Frankle MA. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg 2010;92:2544-56.

Klein SM, Dunning P, Mulieri P, Pupello D, Downes K, Frankle MA. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty. J Bone Joint Surg Am 2010;92:1144-54.

Holcomb JO, Hebert DJ, Mighell MA, Dunning PE, Pupello DR, Pliner MD, Frankle MA. Reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Shoulder Elbow Surg 2010: Oct:19(7):1076-84.

Holcomb JO, Frankle M. Counterpoint: should rotator cuff tears be repaired early? Orthopedics 2010;33:230-1.

Holcomb JO, Cuff D, Petersen SA, Pupello DR, Frankle MA. Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty. J Shoulder Elbow Surg 2009;18:717-23.

Holcomb J, Pupello D, Levy J, Cuff D, Frankle M. Challenging the conclusion, "Clinical outcome was essentially not affected by the notch". J Shoulder Elbow Surg 2009;18:e51-2; author reply e2-3.

Gutierrez S, Luo ZP, Levy J, Frankle MA. Arc of motion and socket depth in reverse shoulder implants. Clin Biomech (Bristol, Avon) 2009;24:473-9.

Frankle MA, Teramoto A, Luo ZP, Levy JC, Pupello D. Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg 2009;18:874-85.

Chacon A, Virani N, Shannon R, Levy JC, Pupello D, Frankle M. Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am 2009;91:119-27.

Virani NA, Harman M, Li K, Levy J, Pupello DR, Frankle MA. In vitro and finite element analysis of glenoid bone/baseplate interaction in the reverse shoulder design. J Shoulder Elbow Surg 2008;17:509-21.

Gutierrez S, Levy JC, Frankle MA, Cuff D, Keller TS, Pupello DR, Lee WE, 3rd. Evaluation of abduction range of motion and avoidance of inferior scapular impingement in a reverse shoulder model. J Shoulder Elbow Surg 2008;17:608-15.

Gutierrez S, Comiskey CAt, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am 2008;90:2606-15.

Cuff DJ, Virani NA, Levy J, Frankle MA, Derasari A, Hines B, Pupello DR, Cancio M, Mighell M. The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg Br 2008;90:336-42.

Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 2008;90:1244-51.

Frankle, Mark. "Reverse Prosthesis for Acute and Chronic Trauma." Arthritis & Arthroplasty: The Shoulder. Philadelphia: Elsevier, 2008.

Levy JC, Virani N, Pupello D, Frankle M. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br 2007;89:189-95.

Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am 2007;89:292-300.

Gutierrez S, Greiwe RM, Frankle MA, Siegal S, Lee WE, 3rd. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg 2007;16:S9-S12.

Frankle M, Mighell M. Re: Shoulder prostheses treating cuff tear arthropathy: a comparative biomechanical study. J Orthop Res 2006;24:112; author reply -3.

Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am 2006;88 Suppl 1 Pt 2:178-90.

Harman M, Frankle M, Vasey M, Banks S. Initial glenoid component fixation in "reverse" total shoulder arthroplasty: a biomechanical evaluation. J Shoulder Elbow Surg 2005;14:162S-7S.

Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am 2005;87:1697-705.

Devinney Scott, Mark Frankle, Mark Mighell, and David Fisher. "Surgery of Shoulder Arthritis." Arthritis and Allied Conditions. Philadelphia: Lippincott Williams & Williams, 2005.

Frankle, Mark. "Revision of Failed Reverse Type Implants." Revision and Complex Shoulder Arthroplasty. Philadelphia: Lippincott Williams and Wilkins, 2005.

Frankle M, Kumar A. Reverse total shoulder replacement for arthritis with an irreparable rotator cuff tear. Techniques in Shoulder & Elbow Surgery 2003;4:77-83.