Background: The Delta III reverse-ball-and-socket total shoulder
implant is designed to restore overhead shoulder function in the presence of
irreparable rotator cuff deficiency by using the intact deltoid muscle and the
stability provided by the prosthetic design. Our purpose was to evaluate the
clinical and radiographic results of this arthroplasty in a consecutive series
of shoulders with painful pseudoparesis due to irreversible loss of rotator
Methods: Fifty-eight consecutive patients with moderate-to-severe
shoulder pain and active anterior elevation of <90° due to an
irreparable rotator cuff tear were treated with a Delta III total shoulder
replacement at an average age of sixty-eight years. Seventeen of the
procedures were the primary treatment for the shoulder, and forty-one were
revisions. The patients were examined clinically and radiographically after an
average duration of follow-up of thirty-eight months.
Results: On the average, the subjective shoulder value increased
from 18% preoperatively to 56% postoperatively (p < 0.0001); the relative
Constant score, from 29% to 64% (p < 0.0001); the Constant score for pain,
from 5.2 to 10.5 points (p < 0.0001); active anterior elevation, from
42° to 100° (p < 0.0001); and active abduction, from 43° to
90° (p < 0.0001). The patients for whom the implantation of the Delta
III prosthesis was the primary procedure and those who had had previous
surgery showed similar amounts of improvement. The total complication rate,
including all minor complications, was 50%, and the reoperation rate was 33%.
Of the seventeen primary operations, 47% (eight) were associated with a
complication and 18% (three) were followed by a reoperation. Of the forty-one
revisions, 51% (twenty-one) were associated with a complication and 39%
(sixteen) were followed by a reoperation. Subjective results and satisfaction
rates were not influenced by complications or reoperations when the prosthesis
had been retained.
Conclusions: Total shoulder arthroplasty with the Delta III
prosthesis is a salvage procedure for severe shoulder dysfunction caused by an
irreparable rotator cuff tear associated with other glenohumeral lesions.
Complications were frequent following both primary and revision procedures,
but they rarely affected the final outcome. The procedure has a substantial
potential to improve the condition of patients with severe shoulder
dysfunction, at least in the short term.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.