Arthroplasty iSAWE 6

Question

A 76 year old woman with pseudoparalysis of the shoulder and a massive irreparable cuff tear has had surgery.

Arthroplasty iSAWE 6, AP radiograph of the shoulder
AP radiograph of the shoulder. Image by Georg Mattiassich, Lucian Lior Marcovici, Rolf Michael Krifter, Reinhold Ortmaier, Peter Wegerer, Albert Kroepfl, Wikimedia Commons, CC BY 2.0.
  1. What procedure is shown and what is its biomechanical rationale?
  2. What are the indications?
  3. What must be checked before surgery?

Answer

Procedure and rationale

  • Reverse total shoulder arthroplasty
  • Medialised and lowered centre of rotation (Grammont)
  • Increases the deltoid lever arm and tensions the deltoid
  • Semi constrained, does not need a functioning supraspinatus
  • Lateralised designs improve rotation and reduce notching

Indications

  • Cuff tear arthropathy (Hamada grade 3 and above)
  • Massive irreparable cuff tear with pseudoparalysis
  • Complex proximal humerus fractures in the elderly
  • Failed anatomic arthroplasty
  • Severe glenoid bone loss or static posterior subluxation
  • Tumour reconstruction

Preoperative checks

  • Deltoid and axillary nerve function
  • Teres minor function for external rotation (hornblower sign)
  • Glenoid bone stock on CT
  • Infection screen in revision
  • Medical fitness, mostly older patients

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.