Resurfacing or Reverse Arthroplasty: Forward or Backward Thinking?

The reverse shoulder arthroplasty has evolved as a form of management for cuff tear arthropathy. This technique however sacrifices a significant amount of bone stock, is technically demanding, has been associated with multiple complications, has a relatively short track record and is significantly more expensive than most other implants. Resurfacing using a cup arthroplasty, however, provides a smooth “seamless” articular surface for the upper humerus under the coracoacromial arch and if needed can be augmented with a fascial arthroplasty. This technique provides substantial pain relief, functional range of motion, preserves bone stock, is readily revisable and is substantially less expensive. For cuff tear arthropathy with a captured humeral head, well maintained beneath coracoacromial arch, resurfacing using a seamless cup arthroplasty placed over the entire humeral head in a valgus orientation, has proven to provide a satisfactory outcome in the majority of patients. Reverse arthroplasty utilizing state-of-the-art surgical technique to ensure appropriate implant positioning, soft tissue tensioning and avoidance of glenoid impingement and notching should be reserved for cases of severe “pseudo-paralysis” with significant superior escape, in patients with adequate bone stock and a well preserved deltoid.