23 January 2026
Pioneering Lateralization: The Evolution of AltiVate® Reverse
Do you know? Enovis has introduced world-first innovations that are fundamentally shaping the future of shoulder arthroplasty. Our commitment to moving orthopaedics forward is rooted in a legacy of "pioneering and proven" design.
In this second appointment of our series, we explore how our past breakthroughs fuel next-generation solutions.
In the late 1990s, Mr. Mark A. Frankle was among the first to develop a reverse shoulder prosthesis that intentionally departed from the original Grammont design principles.
While the Grammont concept was based on medializing and lowering the center of rotation to maximize deltoid efficiency, Frankle explored alternative biomechanical solutions to address some of the limitations associated with excessive medialization, including restricted range of motion, scapular notching, and instability.
This work represented a key milestone in the evolution of reverse shoulder arthroplasty and laid the foundation for implant designs that reconsidered center-of-rotation positioning and implant geometry to improve stability, mobility, and functional outcomes.
Building on this legacy, the AltiVate® Reverse Shoulder System incorporates design principles derived from the clinical success of DJO®’s Reverse Shoulder Prosthesis (RSP™), while integrating enhanced fixation technologies and precision instrumentation.
The system features an optimized humeral stem design based on anatomic CT studies, allowing accurate shell-to-stem positioning and improved matching of patient anatomy in reverse total shoulder constructs [2]. A 135° humeral neck–shaft angle has demonstrated, through biomechanical testing, a reduced potential for inferior scapular notching [1].
AltiVate Reverse remains based on a lateralised center of rotation. With seven glenosphere size options, the system enables center-of-rotation positioning close to the anatomic COR, optimizing compatibility across a wide range of anatomies.
Precision instrumentation supports both metaphyseal- and diaphyseal-referenced techniques, allowing surgeons to select their preferred approach while maintaining a streamlined and reproducible workflow.
To further address anatomical variability, AltiVate Reverse offers two humeral shell sizes (Standard and Small), combined with e+™ liners manufactured from highly crosslinked vitamin E–stabilized polyethylene to maintain mechanical strength and reduce wear rates [2].
On the glenoid side, the RSP monoblock design with central compression screw fixation has demonstrated greater than 90% survivorship at 10-year follow-up [2,3]. Stable fixation has been shown even in challenging bone-loss scenarios with as little as 50% backside coverage [4], while the P2™ porous coating supports bone apposition and long-term osseointegration [5].
Together, these design features aim to provide improved short- and long-term fixation on both the humeral and glenoid sides, creating optimal conditions for durable stability and bony ingrowth.
Bibliography
[1] Gutierrez S, Comiskey C, Lou Z, Pupello D, Frankle M. Range of Impingement-Free Abduction and Adduction Deficit After Reverse Shoulder Arthroplasty. Hierarchy of Surgical and Implant-Design-Related Factors. J Bone Joint Surg Am. 2008 Dec;90(12):2606-15.
[2] Data on file at DJO®. Laboratory testing does not necessarily indicate clinical performance.
[3] Beck et al. Bone response to load bearing percutaneous osseointegrated implants for amputees: a sheep amputation model. Poster 2085 at the 57th Annual Meeting of the Orthopaedic Research Society. 2011.
[4] Frankle MA, Virani N, Pupello D, Gutierrez S. Rational and Biomechanics of the Reverse Shoulder Prosthesis: The American Experience in Rotator Cuff Deficiency of the Shoulder. Thieme. 2008
[5] Gutierrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am 2008;90:2606-15.
