title: The TESS reverse shoulder arthroplasty without a stem in the treatment of cuff-deficient shoulder conditions: clinical and radiographic results.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Carémeau Teaching Hospital Center, Nîmes, France. Electronic address: phil.teissier@gmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Teissier
authors.affiliation: Clinique Saint-Jean, OrthoSud Shoulder Unit, Montpellier, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Teissier
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Carémeau Teaching Hospital Center, Nîmes, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Kouyoumdjian
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Carémeau Teaching Hospital Center, Nîmes, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Asencio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D020069:Shoulder Pain / Q000601:surgery; D016896:Treatment Outcome
keywords: Reverse shoulder arthroplasty; humeral fixation; rotator cuff arthropathy; scapular notching; shoulder; shoulder arthroplasty; stemless prosthesis