20 YEARS OF RSP – THE 5 MOST IMPORTANT LESSONS I’VE LEARNED

Abstract

Introduction and aim This paper reports on 5 key aspects to consider when planning a successful RSA procedure, including patient selection, glenosphere positioning, glenoid fixation, humeral fixation, and soft tissue management/tensioning. Material, methods, results, and discussion Key in patient selection for RSA is understanding the relationship between indications, outcomes, patient mental state, and their expectations. When placing a glenosphere, prioritize sound principles of shoulder kinematics but always consider bone preservation and ease of placement. Glenoid fixation must take advantage of structural features of individual implant designs while factoring in specific-bone morphology/morphometry to optimize the resultant glenohumeral loading. For the stem, fixation prioritizes press-fit where bone quality and quantity permit. Always aim to achieve anatomical pivot point restoration with planning for stem position and avoid distalization that may lead to nerve injury and scapular spine fractures. Conclusions To increase the chances of a successful RSA procedure, a surgeon should emphasize picking the right patient, placing the implant in an optimum position, ensuring adequate glenoid and humeral fixation, and correctly balancing soft tissues. Keywords: reverse shoulder arthroplasty, surgeon education, patient optimization