The development of modern shoulder replacement surgery started over half a century ago with the pioneering work done by CS Neer. Several designs for
shoulder prostheses are now available, allowing surgeons to select the best design for each situation. When the rotator cuff is intact, unconstrained
prostheses produce reliable and reproducible results, with
prosthesis survival rates of 97% after 10 years and 84% after 20 years. In patients with three- or four-part fractures of the proximal humerus, the outcome of shoulder
arthroplasty depends largely on healing of the greater tuberosity, which is therefore a major treatment objective. Factors crucial to greater tuberosity union include selection of the optimal prosthesis design, flawless fixation of the tuberosities, and appropriate postoperative immobilization. The reverse
shoulder prosthesis developed by Grammont has been recognized since 1991 as a valid option for patients with glenohumeral
osteoarthritis. Ten-year
prosthesis survival rates are 91% overall (including
trauma and revisions) and 94% for glenohumeral
osteoarthritis with head migration. These good results are generating interest in the reverse
shoulder prosthesis as a treatment option in situations where unconstrained
prostheses are unsatisfactory (primary glenohumeral
osteoarthritis with marked glenoid cavity erosion;
comminuted fractures in patients older than 75 years; post-traumatic
osteoarthritis with severe tuberosity malunion or nonunion; massive irreparable
rotator cuff tears with pseudoparalysis; failed rotator cuff repair; and proximal humerus
tumor requiring resection of the rotator cuff insertions).