title: A history of reverse total shoulder arthroplasty.
abstract: BACKGROUND
  Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs.
  
  
  OBJECTIVE
  This review explores the development of reverse shoulder arthroplasty, specifically describing (1) the evolution of reverse shoulder arthroplasty designs, (2) the biomechanical variations in the evolution of this arthroplasty, and (3) the current issues relevant to reverse shoulder arthroplasty today.
  
  
  METHODS
  Using a PubMed search, the literature was explored for articles addressing reverse shoulder arthroplasty, focusing on those papers with historical context.
  
  
  RESULTS
  Results of the early designs were apparently poor, although they were not subjected to rigorous clinical research and usually reported only in secondary literature. We identified a trend of glenoid component failure in the early reverse designs. This trend was recognized and reported by authors as the reverse shoulder evolved. Authors reported greater pain relief and better function in reverse shoulder arthroplasty with the fundamental change of Grammont's design (moving the center of rotation medially and distally). However, current reports suggest lingering concerns and challenges with today's designs.
  
  
  CONCLUSIONS
  The history of reverse shoulder arthroplasty involves the designs of many forward-thinking surgeons. Many of these highly constrained systems failed, although more recent designs have demonstrated improved longevity and implant performance. Reverse shoulder arthroplasty requires ongoing study, with challenges and controversies remaining around present-day designs.
authors.affiliation: Leni & Peter May Department of Orthopaedic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029, USA. evan.flatow@mssm.edu
authors.forename: Evan L
authors.initials: EL
authors.lastname: Flatow
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Harrison
mesh_terms: D001168:Arthritis / Q000000981:diagnostic imaging / Q000266:history* / Q000503:physiopathology / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000266:history* / Q000295:instrumentation; D001696:Biomechanical Phenomena; D049673:History, 20th Century; D006801:Humans; D007595:Joint Prosthesis / Q000266:history; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome