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The risks and complication profile of reverse total shoulder arthroplasty (RSA) in rheumatoid arthritis (RA) patients has yet to be clearly defined as most studies have small cohorts. Using a large inpatient database, the purpose on our study was to determine the overall demographics, hospitalization characteristics, and early complication rates in rheumatoid patients and compared these to rotator-cuff arthropathy patients without RA undergoing RSA. Utilizing United States Nationwide Inpatient Sample from 2010 to 2013, we evaluated a total of 919 RA RSA and compared them to 8097 patients without RA undergoing RSA. The outcomes included demographic characteristics like age, race, sex, Deyo comorbidity score, perioperative complications, and mean length-of-stay. The RA cohort had 81% females versus 60% in the comparison cohort. This cohort was younger (p = 0.006) and had longer hospitalization time (p = 0.001), but the total inpatient costs were not significantly different (p = 0.15). In regards to Deyo index, rheumatoid patients had significantly higher scores (p < 0.001). The inpatient complication rates for infection (p = 0.9), nerve injury (p = 0.9), and instability (p = 0.19) were similar, but the RA cohort had more prosthetic-related (p = 0.001) and greater tuberosity-related (p = 0.008) complications. The mortality rates were also similar (p = 0.625). In RSA for RA patients, surgeons should be mindful of preoperative risk factors and demographic characteristics that may influence their outcomes. Caution should specifically be paid to the possibility of longer hospitalization time and increased incidence of certain complications, including intraoperative fracture, when compared to non-rheumatoid patients. Close collaboration between rheumatologists, surgeons, and primary care physicians is a must for optimizing and managing these patients.

Background: Reverse total shoulder arthroplasty (RSA) is a recent concept that enables good functional outcomes in cases of massive rotator cuff tear and cuff tear arthropathy. Design parameters influence the functional results and complications. The purpose of this study is to present the results of a novel RSA, the Total Evolutive Shoulder System (TESS; Biomet, Warsaw, IN, USA), based on a reverse corolla without a stem., Methods: We enrolled 101 patients with 105 RSAs in a prospective study, with a minimum follow-up period of 24 months. The analysis concerned 91 RSAs in 87 patients (61 men and 26 women), with a mean age of 73 years, at a mean follow-up of 41 months (range, 24-69 months)., Results: Ninety-six percent of patients rated their satisfaction as good or excellent. Mean flexion was 143° (range, 90°-170°), and mean external rotation was 39° (range, 20°-70°). The Constant score improved from 40 points preoperatively to 68 points at last follow-up (P < .001). The mean American Shoulder and Elbow Surgeons score was 24 points. The mean neck-shaft angle was 154° (range, 142°-165°). Inferior scapular notching occurred in 17 cases (19%). The notching rate was higher when the glenometaphyseal angle increased (P < .001), when the inferior tilt decreased (P = .003), and when the neck-shaft angle increased. There was no evidence of component loosening., Conclusion: TESS RSA provided encouraging midterm results with favorable outcomes and a low rate of complications. The stemless TESS with a reverse corolla is a reliable, less invasive system., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Osteoporosis and osteopenia are frequently found in patients undergoing shoulder surgery, especially rotator cuff repair, and it is anticipated that this link will become more common as more elderly people have operations on their shoulders. For orthopedic surgical candidates who are at high risk, preoperative screening may identify those who might benefit from early intervention and prevent any associated adverse events. The major complications include repair failure and revision surgery. Antiresorptive medication preoperatively has shown good results in vivo. However, when used in the clinical setting, the efficacy remains controversial. Surgical management may include repair augmentation and placing the anchors in the posteromedial part of the greater tuberosity. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Reverse shoulder arthroplasty (RSA) was initially developed for rotator cuff arthropathy but has been expanded to treat comminuted proximal humerus fractures. Few studies have compared RSA for traumatic and degenerative indications. We present the first report of mid-term outcomes of RSA comparing both indications in an Asian population. Methods: 113 degenerative and 20 fracture patients underwent RSA from 2010 to 2019. Patients with degenerative indications were 4:1 propensity-score matched to fractures and adjusted for age and sex. Patients were assessed for range of motion (ROM), strength, pain, Constant-Murley score (CMS), University of California Los Angeles Shoulder Score (UCLA) and Oxford shoulder score (OSS) preoperatively, at 6-months and 1-year. Patients' satisfaction, expectation fulfilment and minimal clinically important difference (MCID) were analysed. Results: Degenerative patients had better ROM, isometric strength and CMS at 6-months, although at 1-year only abduction was superior (104.8 ± 17.3° vs 86.7 ± 19.8°). No significant differences in pain, UCLA and OSS were observed. Most improvements occurred within 6 months. Similar proportions of patients were satisfied (83.3% vs 73.3%, p = 0.460) and attained MCID (85.0% vs 86.7%, p = 1.000) at 1-year. Discussion: Although initially exhibiting slower recovery, patients with proximal humerus fractures can expect similar functional recovery and satisfaction at 1-year compared to those who received RSA for degenerative indications. [ABSTRACT FROM AUTHOR]

Increasing evidence exists regarding the impact of primary diagnosis on clinical outcomes following reverse total shoulder arthroplasty (RTSA). Expanding indications coupled with emerging clinical evidence has resulted in increased use of RTSA for glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. The ability to return to sports after RTSA is a common concern for patients; however, most literature evaluating this does not stratify patients by diagnosis. The purpose of this investigation was to evaluate the effect of diagnosis on return to sports after RTSA. A single institution, retrospective study was performed on patients who underwent primary RTSA with a minimum 2-year follow-up. Patients answered a 7-question survey regarding sport participation within 3 years before surgery and the level to which they returned to their sports after surgery. Patient demographics, patient-reported outcome scores, and range of motion were accessed from the database. Descriptive statistics and univariate analysis were performed to assess differences between patients who did not return to sport or did so at lower level and those that returned at the same or higher level, as well as between patients with GHOA and those with rotator cuff disease. Binary logistic regression was performed to assess predictors of returning to sports. A total of 106 patients meeting inclusion criteria were identified with a mean age of 72 years (range, 55-88 years). Ninety-six patients (90.6%) returned to playing sports, of which 84 (87.5%) returned at the same or higher level. Patients with GHOA demonstrated a higher rate of return to sport compared to those with rotator cuff disease (95.6% vs. 81.6%; P =.033). Logistic regression controlling for sport intensity demonstrated that GHOA is a predictor of returning to sports (odds ratio = 6.3; P =.017). Patients who did not return to sports or did so at a lower level had higher preoperative pain (P =.007), lower postoperative SANE (Single Assessment Numerical Evaluation of the Shoulder) (P =.027), lower preoperative and postoperative ASES (American Shoulder and Elbow Surgeons) scores (P =.004 and P =.016, respectively), less preoperative and postoperative forward elevation (P =.037 and P =.019, respectively), lower postoperative external rotation (P =.004), and lower preoperative internal rotation (P =.027). The ability of patients to return to sports after RTSA is highly influenced by preoperative diagnosis. Patients with GHOA have higher rates of return to sport than previously recognized. These results are useful for establishing expectations with patients regarding their postoperative activity level. [ABSTRACT FROM AUTHOR]

Purpose: Scapular Notching (SN) is one of the most common postoperative complications for a patient after Reverse Total Shoulder Arthroplasty (RTSA). Despite employing various strategies to mitigate SN risk, the overall incidence remains far from zero. This article introduces a new risk factor, the scapulo-humeral angle (SHA), as a key element influencing the risk for SN.A retrospective analysis was conducted on all patients who underwent RTSA for rotator cuff arthropathy at the study centre. The preoperative SHA was measured, and the presence of SN was investigated and graded using the Nerot classification at the latest follow-up.42 patients were included. 12 presented SN (incidence 28.5%). A statistically significant Pearson coefficient correlation between pre-operative SHA and the incidence of SN was observed (r= -0.6954; 95% C.I. -0,8250 to -0,4963; p < 0.0001). A statistically significant Pearson coefficient correlation was also found between the degree of SN and the pre-operative SHA (r= -0,7045; 95% C.I. -0,8306 to -0,5096; P value (two-tailed) < 0,0001, alpha 0.05).The primary finding is a statistically significant correlation between a reduced preoperative SHA and an increased incidence of postoperative SN. The secondary finding is that a smaller preoperative SHA is associated with a more severe degree of SN A SHA cut-off of 50° distinguished patients at high risk of SN from those at low risk. All patients with an SHA below 50° developed SN (10/10), whereas only 6.25% of patients with an SHA exceeding 50° experienced SN (2/32).Methods: Scapular Notching (SN) is one of the most common postoperative complications for a patient after Reverse Total Shoulder Arthroplasty (RTSA). Despite employing various strategies to mitigate SN risk, the overall incidence remains far from zero. This article introduces a new risk factor, the scapulo-humeral angle (SHA), as a key element influencing the risk for SN.A retrospective analysis was conducted on all patients who underwent RTSA for rotator cuff arthropathy at the study centre. The preoperative SHA was measured, and the presence of SN was investigated and graded using the Nerot classification at the latest follow-up.42 patients were included. 12 presented SN (incidence 28.5%). A statistically significant Pearson coefficient correlation between pre-operative SHA and the incidence of SN was observed (r= -0.6954; 95% C.I. -0,8250 to -0,4963; p < 0.0001). A statistically significant Pearson coefficient correlation was also found between the degree of SN and the pre-operative SHA (r= -0,7045; 95% C.I. -0,8306 to -0,5096; P value (two-tailed) < 0,0001, alpha 0.05).The primary finding is a statistically significant correlation between a reduced preoperative SHA and an increased incidence of postoperative SN. The secondary finding is that a smaller preoperative SHA is associated with a more severe degree of SN A SHA cut-off of 50° distinguished patients at high risk of SN from those at low risk. All patients with an SHA below 50° developed SN (10/10), whereas only 6.25% of patients with an SHA exceeding 50° experienced SN (2/32).Results: Scapular Notching (SN) is one of the most common postoperative complications for a patient after Reverse Total Shoulder Arthroplasty (RTSA). Despite employing various strategies to mitigate SN risk, the overall incidence remains far from zero. This article introduces a new risk factor, the scapulo-humeral angle (SHA), as a key element influencing the risk for SN.A retrospective analysis was conducted on all patients who underwent RTSA for rotator cuff arthropathy at the study centre. The preoperative SHA was measured, and the presence of SN was investigated and graded using the Nerot classification at the latest follow-up.42 patients were included. 12 presented SN (incidence 28.5%). A statistically significant Pearson coefficient correlation between pre-operative SHA and the incidence of SN was observed (r= -0.6954; 95% C.I. -0,8250 to -0,4963; p < 0.0001). A statistically significant Pearson coefficient correlation was also found between the degree of SN and the pre-operative SHA (r= -0,7045; 95% C.I. -0,8306 to -0,5096; P value (two-tailed) < 0,0001, alpha 0.05).The primary finding is a statistically significant correlation between a reduced preoperative SHA and an increased incidence of postoperative SN. The secondary finding is that a smaller preoperative SHA is associated with a more severe degree of SN A SHA cut-off of 50° distinguished patients at high risk of SN from those at low risk. All patients with an SHA below 50° developed SN (10/10), whereas only 6.25% of patients with an SHA exceeding 50° experienced SN (2/32).Conclusions: Scapular Notching (SN) is one of the most common postoperative complications for a patient after Reverse Total Shoulder Arthroplasty (RTSA). Despite employing various strategies to mitigate SN risk, the overall incidence remains far from zero. This article introduces a new risk factor, the scapulo-humeral angle (SHA), as a key element influencing the risk for SN.A retrospective analysis was conducted on all patients who underwent RTSA for rotator cuff arthropathy at the study centre. The preoperative SHA was measured, and the presence of SN was investigated and graded using the Nerot classification at the latest follow-up.42 patients were included. 12 presented SN (incidence 28.5%). A statistically significant Pearson coefficient correlation between pre-operative SHA and the incidence of SN was observed (r= -0.6954; 95% C.I. -0,8250 to -0,4963; p < 0.0001). A statistically significant Pearson coefficient correlation was also found between the degree of SN and the pre-operative SHA (r= -0,7045; 95% C.I. -0,8306 to -0,5096; P value (two-tailed) < 0,0001, alpha 0.05).The primary finding is a statistically significant correlation between a reduced preoperative SHA and an increased incidence of postoperative SN. The secondary finding is that a smaller preoperative SHA is associated with a more severe degree of SN A SHA cut-off of 50° distinguished patients at high risk of SN from those at low risk. All patients with an SHA below 50° developed SN (10/10), whereas only 6.25% of patients with an SHA exceeding 50° experienced SN (2/32). [ABSTRACT FROM AUTHOR]

Background: Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. Methods: We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t -test and proportions using the Chi-square test. Results: Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2–87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0–14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (−7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. Conclusions: In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low. Level of evidence: IV; Case series. [ABSTRACT FROM AUTHOR]

Purpose: Baseplate positioning may affect clinical outcome after reverse total shoulder arthroplasty (RTSA). The aim of this study was to evaluate the risk of penetration of the baseplate peg in RTSA. Methods: Forty-four patients with rotator cuff arthropathy or massive rotator cuff tears were included. Using their computed tomography data, ten insertion patterns of the baseplate pegs were simulated. First, in the axial plane, the baseplate was placed perpendicular to the Friedman axis (Friedman placement) and parallel to the glenoid surface (glenoid placement). Second, each of these placements were classified into the following groups: The baseplate peg was placed 2 mm anterior to the long axis of the glenoid (group A2), 1 mm anterior (group A1), on the long axis (group C0), 1 mm posterior (group P1), and 2 mm posterior (group P2). Cases in which the baseplate peg was within the scapular neck were defined as non-penetration, and the non-penetration rates among each group were evaluated and compared between sexes, and their relationship with patient height was evaluated. Results: In both the Friedman and glenoid placements, the non-penetration rate was significantly higher in groups A2 (68.2% and 70.5%) and A1 (65.9% and 65.9%) compared with groups P1 (18.2% and 29.5%) and P2 (9.1% and 13.6%; p < 0.001) and in males than in females (p < 0.05). Furthermore, the non-penetration rate tended to be higher as the patient's height increased. Conclusions: It is recommended that the baseplate peg be placed anterior to the long axis of the glenoid. [ABSTRACT FROM AUTHOR]

Optimal postoperative distalization (DSA) and lateralization (LSA) shoulder angles have been described as radiological measurements correlated with function after reverse shoulder arthroplasty (RSA). The proposed optimal values are DSA between 40° and 65° and LSA between 75° and 95°; however, whether these values can be reached with different implant designs is unclear. To determine which RSA implant could achieve higher rates of optimal DSA and LSA, to determine any association between each implant and optimal DSA and LSA, and to assess the correlation of the preoperative critical shoulder angle (CSA) and acromial index (AI) with the DSA and LSA. This was a retrospective comparative study of all patients who underwent primary RSA for rotator cuff arthropathy. Three RSA implant designs were included, based on which patients were divided into three groups: group 1 (FH Arrow™; 16 patients) comprised onlay implants with a 135° neck-shaft angle (NSA); group 2 (Biomet Comprehensive™; 20 patients) comprised onlay implants with a 147° NSA; group 3 (Mathys Affinis™; 15 patients) comprised inlay implants with a 155° NSA. The AI and CSA were measured on preoperative radiographs. The DSA and LSA were measured on true AP postoperative radiographs. The mean DSAs were 44°, 46°, and 46° (P = 0.671) and the mean LSAs were 92°, 91°, and 82° for groups 1, 2, and 3, respectively (P = 0.003). Group 3 had lower LSA than groups 1 (−10°; P = 0.005) and 2 (–9°; P = 0.002). Optimal DSA and LSA were achieved in 71% and 73% of all arthroplasties, respectively. No association between implant designs and achieving an optimal DSA or LSA was observed. None of the implant designs had DSA >65°. The most common cause of failure to reach an optimal LSA in onlay implants was a combination of LSA >95° and DSA <40°. The most common cause of failure in group 3 was DSA <40°. The DSA was negatively correlated with the AI (−0.384; P = 0.006) and CSA (−0.305; P = 0.033). No correlation was observed between the LSA and AI (P = 0.312) or CSA (P = 0.137). The LSA is lower with the Mathys Affinis™ implant than with the Biomet Comprehensive™ and FH Arrow™ implants; however, most LSAs are in the optimal ranges, and no association is observed between different implant designs and optimal DSA and LSA. Implant design, CSA, and AI should be considered during preoperative planning to achieve optimal DSA and LSA. [ABSTRACT FROM AUTHOR]

Although reverse shoulder arthroplasty is used in massive rotator cuff tears, it is also used in proximal humerus fractures and shoulder arthroplasty revision. In this study, we aimed to examine the early radiological and clinical results of patients undergoing reverse shoulder arthroplasty with different diagnoses. Between 2010 and 2013, reverse shoulder arthroplasty was applied to 10 patients (4 men, 6 women) with the diagnosis of arthropathy due to rotator cuff tear (n: 7), multi-fragmentary proximal humerus fracture (n: 2) and hemiarthroplasty revision (n: 1). The median age of the patients was 74 (64-85) years and the median follow-up was 15.5 (3-35) months. Patients were assessed in terms of joint range of motion, Constant score and Visual Pain Scale (VAS) and radiological examinations before and after surgery. Preoperative active shoulder flexion, abduction, internal and external rotation degrees of the patients were 65, 30, 40 and 50 degrees, and 105, 95, 30, 57.5 degrees respectively in their final controls. Constant score was 20.5 (14-63) preoperatively, and 54.5 (38-64) in the final controls (p‹0.05). While the preoperative VAS was 7 (3-9), it was found to be 1.5 (1-3) in the final controls (p‹0.05). As a complication, scapular notching was observed in one patient. Internal external rotation values were better in the rotator cuff arthropathy group than the fracture group. Reverse shoulder arthroplasty, especially in the treatment of patients with rotator cuff arthropathy, has good early results and a low complication rate. We recommend paying attention to the glenoid component location to avoid scapular notching. [ABSTRACT FROM AUTHOR]

We aimed to investigate whether combined reverse total shoulder arthroplasty (RTSA) and subscapularis repair leads to improved clinical and functional outcome in comparison with RTSA alone. Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "reverse" AND "shoulder" AND "arthroplasty" AND "with" AND "subscapularis" AND "repair". From the 72 initial studies, we finally chose five studies which were eligible to our inclusion-exclusion criteria. The total mean modified Coleman methodology test was 55/100 (range: 47/100 to 60/100). The eligible studies included 1087 patients, in total. Regarding the subjective functional scores as well as range of motion (ROM), the differences amongst groups were insignificant in almost all studies. The mean complications' rate of the repair group was 10.4%, whereas the respective rate of the nonrepair group was 10.2%. All studies concluded that the repair of subscapularis did not affect the complications' rate of patients who were treated with RTSA. The mean dislocations' rates of the repair and the nonrepair group were 1.5% and 2.3%, respectively. Although subscapularis repair was proven safe and effective for the augmentation of RTSA, it did not offer any additional clinical or functional benefit in the outcome of patients treated with lateralized RTSA. Therefore, it is not supported its routine use for patients who have a preoperatively sufficient subscapularis tendon. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature. [ABSTRACT FROM AUTHOR]

The article presents a study which explored the management of painful irreparable shoulder rotator cuff tear through arthroscopic suprascapular neurotomy. The study obtained the mean preoperative Oxford Shoulder Score (OSS) among patients with massive irreparable cuff tear. Results suggested that suprascapular neurotomy is a reproducible technique since it can provide patients with medium-term benefit.

Background: Hemiarthroplasty was the treatment of choice for rotator cuff tear arthropathy (CTA) before the introduction of the reverse total shoulder arthroplasty (RTSA). The purpose of this study was to compare our outcomes for hemiarthroplasty with those for RTSA. Methods: The records of patients with the diagnosis of CTA who had received either a hemiarthroplasty or RTSA from 1997 to 2007 were reviewed. A minimum of 2 years’ follow-up was required. Active shoulder elevation, external rotation, internal rotation, and Shoulder Pain and Disability Index (SPADI) scores were obtained. Statistical analysis was performed comparing function, pain, and range of motion of hemiarthroplasty patients with RTSA patients. Results: We identified 56 shoulder arthroplasties in 50 patients with a minimum of 2 years’ follow-up. There were 20 hemiarthroplasties and 36 RTSAs performed. The mean follow-up was 4.4 years (range, 2-12 years) in the hemiarthroplasty group and 3 years (range, 2-5 years) in the RTSA group. The mean age in the hemiarthroplasty group was 64 years versus 72 years in the RTSA group (P < .05). SPADI scores improved in both groups. However, after follow-up of 2 years or greater, the mean SPADI scores were significantly better (lower) in the RTSA group (34) than in the hemiarthroplasty group (58) (P = .005). Active elevation was significantly better in the RTSA group at all postoperative time periods. The complication rate for both groups was 25%. Conclusions: RTSA performs better than hemiarthroplasty in terms of pain relief, function, and active elevation at 2-year follow-up. [Copyright &y& Elsevier]

Background: The purpose of this study was to describe the pathoanatomy of patients diagnosed with rheumatoid arthritis and rotator cuff deficiency and report their outcomes following reverse shoulder arthroplasty. Methods: Twenty-one shoulders were evaluated prospectively. Nine had no prior surgery, 9 had a failed rotator cuff repair, and 3 had a failed arthroplasty. Patients were followed for a minimum of 2 years (average, 36 months). All patients had preoperative radiographs and 19 shoulders had an MRI or CT available for evaluation of muscular and bony deficiency. Radiographs at most recent follow-up were evaluated for loosening and scapular notching. Results: All outcome measures improved significantly: ASES scores improved from 28 preoperatively to 82 postoperatively (P < .0001); SST scores improved from 1 to 7 (P < .0001); VAS pain scores improved from 7 to 1 (P < .0001); VAS function scores improved from 3 to 6 (P =.0058); elevation improved from 52° to 126° (P < .0001); abduction improved from 55° to 116° (P =.0002); external rotation improved from 19° to 33° (P =.02); and internal rotation improved from S1 to L4 (P =.02). Twelve patients rated their outcome as excellent, 6 as good, 2 as satisfactory, and 1 as unsatisfactory. Severe glenoid erosion was seen in 10 of the shoulders and 5 of the defects required structural grafting. Three patients (14%) sustained a complication that required reoperation: 2 for infection and 1 for periprosthetic fracture. Conclusions: In patients with rheumatoid arthritis and rotator cuff deficiency, reverse shoulder arthroplasty can provide improvement in function and decreased pain. [ABSTRACT FROM AUTHOR]