Surgical Technique, EN
SMR Reverse
Balanced by Design
Being part of the SMR System, SMR Reverse offers different modular options for stemmed Reverse Shoulder Arthroplasty, from bone sparing to revision solutions.
Evolved Modularity
Enovis is a true pioneer in the modularity field: SMR has been the first to address multiple indications of shoulder replacement with a unique modular system, and its options keep evolving towards the future, extending indications and improving outcomes.
Reliable Fixation
SMR can provide multiple fixation strategies -cement, press-fit, TT bone ingrowth both on humerus and on glenoid side and they are all proved to be reliable.
Proven Performance
Proven results make SMR having one of the widest clinical heritage among all the shoulder replacements worldwide.
About
SMR Reverse is designed to provide a complete solution for orthopedic surgeons.
Modularity is the enabling feature of this platform. SMR Reverse can support any kind of shoulder arthroplasty, from elective to trauma, from bone-sparing primary to revision cases [2-11].
SMR Reverse has been awarded with a 10A ODEP rating [1].
By reversing the bearing materials of a typical reverse shoulder replacement, SMR Reverse offers a cross-linked HP polyethylene glenosphere with a superior chamfer for easier implantation, while the inferior rim allows a better load distribution. Reverse liners in CoCr alloy are available in different sizes and with pure lateralizing options. A ceramic reverse liner option for allergic patients is also available. [10-13].
SMR Reverse HP has also been awarded with a 10A ODEP rating [1].
BIBLIOGRAPHY
[1] 10A ODEP Rating for SMR Cemented Glenoid / Uncemented Humeral Stem. Latest ODEP Ratings can be found at www.odep.org.uk
[2] Kirsch JM, Khan M, Thornley P, Gichuru M, Freehill MT, Neviaser A, Moravek J, Miller BS, Bedi A. Platform shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2018;27(4):756-3.
[3] Weber-Spickschen TS, Alfke D, Agneskirchner JD. The use of a modular system to convert an anatomical total shoulder arthroplasty to a reverse shoulder arthroplasty: Clinical and radiological results. Bone Joint J. 2015 Dec;97-B(12):1662-7
[4] Castagna A, Delcogliano M, de Caro F, Ziveri G, Borroni M, Gumina S, Postacchini F, De Biase CF. Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system. Int Orthop. 2013 Jul;37(7):1297-305.
[5] Castagna A., Randelli M., Garofalo R., Maradei L., Giardella A., Borroni M. Mid-Term results of a metalbacked glenoid component in total shoulder replacement. J Bone Joint Surg [Br], 92(10): 1410-1415, 2010
[6] Ross M, Hope B, Stokes A, Peters SE, McLeod I, Duke PF. Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly. J Shoulder Elbow Surg. 2014 Aug 26
[7] Boyle MJ, Youn SM, Frampton CM, Ball CM. Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg. 2013 Jan;22(1):32-7.
[8] Martinez AA. Calvo A, Bejarano C, Carbonel I, Herrera A. The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus. J Orthop Sci. 2012 Mar;17(2):141–7.
[9] Young S.W., Everts N.M., Ball C.M., Astley T.M., Poon P.C. The SMR reverse shoulder prosthesis in the treatment of cuff-deficient shoulder conditions. J Shoulder Elbow Surg, 18(4): 622-626, 2009.
[10] Poon P.C., Chou J., Young D., Malak S. F., Anderson I.A. Biomechanical evaluation of different designs of glenospheres in the SMR reverse shoulder prosthesis: micromotion of the baseplate and risk of loosening. Shoulder & Elbow, 2: 94– 99, 20100.
[11] Bloch HR, Budassi P, Bischof A, Agneskirchner J, Domenghini C, Frattini M, Borroni M, Zoni S, Castagna A. Influence of glenosphere design and material on clinical outcomes of reverse total shoulder arthroplasty. Shoulder & Elbow 2014;6:156-64.
[12] Merolla G, Tartarone A, Sperling JW, Paladini P, Fabbri E, Porcellini G. Early clinical and radiological outcomes of reverse shoulder arthroplasty with an eccentric all polyethylene glenosphere to treat failed hemiarthroplasty and the sequelae of proximal humeral fractures. Int Orthop. 2017;41(1):141-8.
[13] Poon P.C., Chou J., Young D., Malak S. F., Anderson I.A. Biomechanical evaluation of different designs of glenospheres in the SMR reverse shoulder prosthesis: micromotion of the baseplate and risk of loosening. Shoulder & Elbow, 2: 94– 99, 20100.
Sizing and Options
The design of SMR Reverse is to be used with both cemented and uncemented stems. It features dedicated metaphyseal components to support elective and trauma surgery. Ø 36mm CoCr glenospheres (concentric or with 4mm eccentricity) can be balanced with several thicknesses of reverse liners. Reverse HP glenospheres in polyethylene (Ø40mm, Ø44mm and Ø44mm corrective) can also be coupled with different liners, including lateralizing options.
On glenoid side, different options are available, from uncemeneted monoblock Metal-Back to modular options as SMR Axioma TT Metal-Back and SMR TT Augmented 360 Metal-Back.
In particular, SMR Axioma TT Metal Back, thanks to the modular peg in Trabecular Titanium available in 2 diameters and 4 different lengths, offers greater primary fixation and favors an improved biological integration of the implants. An additional instrument set has been developed to allow step-by-step bone graft preparation to restore the joint line by filling in glenoid defects. Different options of bone graft are available: flat graft (5, 10 or 15mm) or sloped (15° or 20°).
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