Lateral Versus Medial Offset Design for Reverse Shoulder Replacement

Jason C. Ho, MD; Liam T. Kane, BS; Joseph A. Abboud, MD


Curr Orthop Pract. 2019;30(3):200-207. 

In This Article

Abstract and Introduction


Reverse total shoulder arthroplasty (RTSA) has become significantly more popular in recent years due to expanding indications and successful long-term outcomes being reported. RTSA has undergone several iterations throughout history that has led to modern-day designs. What initially started as a salvage procedure for cuff-deficient shoulders is now commonly used for a variety of reconstructive shoulder problems not limited just to those without a functioning rotator cuff. The goal of this article was to compare and contrast lateral and medial offset designs for RTSA. Details of both glenoid and humeral-sided design characteristics are discussed as well as existing biomechanical and clinical literature for both designs.


The reverse total shoulder arthroplasty (RTSA) has gone through several iterations in history to arrive at today's modern design.[1] The RTSA was proposed as a solution to the high rate of failure in anatomic total shoulder arthroplasty (TSA) with rotator cuff dysfunction, particularly for elderly, low-demand patients. Although earlier designs had failed because of biomechanical issues and design flaws associated with reversing the ball and the socket of the glenohumeral joint, Paul Grammont's 1985 design helped solve the previously difficult-to-manage problem of cuff tear arthropathy and the treatment for a cuff-deficient shoulder. He did this by utilizing the deltoid as a lever for elevation in the absence of a functional rotator cuff while maintaining the structural integrity of the implant to prevent catastrophic failure.[2–6] Grammont's design achieved widespread use in Europe and eventually was approved by the Federal Drug Administration (FDA) for use in the United States in 2003. The potential of RTSA grew as surgeons began observing predictable pain relief, restoration of motion, and improved functional outcomes with acceptable complication rates. As time progressed and the orthopaedic community gained more experience with this implant, indications for RTSA expanded to now include revision surgery, proximal humeral fractures, sequelae of proximal humeral fractures, glenohumeral arthritis, chronic glenohumeral dislocations, and massive humeral and/or glenoid bone loss.[3,4,7–18]