1240 THE JOURNAL OF BONE AND JOINT SURGERY  UPPER LIMB An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years B. Melis, M. DeFranco, A. Lädermann, D. Molé, L. Favard, C. Nérot, C. Maynou, G. Walch From Centre Orthopédique Santy, Lyon, France  B. Melis, MD, Orthopaedic Surgeon  G. Walch, MD, Orthopaedic Surgeon Centre Orthopédique Santy, 24 Av Paul Santy, 69008 Lyon, France.  M. DeFranco, MD, Orthopaedic Surgeon Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075, USA.  A. Lädermann, MD, Orthopaedic surgeon University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland.  D. Molé, MD, Orthopaedic Surgeon Clinique de Traumatologie et d’Orthopédie, 49 Rue Hermite, 54000 Nancy, France.  L. Favard, MD, Orthopaedic Surgeon CHU Trousseau, Chirurgie Orthopédique et Traumatologique, Avenue de la République, 37170 Chambray- lès-Tours, France.  C. Nérot, MD, Orthopaedic Surgeon CHU de Reims, Traumatologie, 45 avenue Cognacq Jay, 51100 Reims, France.  C. Maynou, MD, Orthopaedic Surgeon CHRU de Lille, service de Chirurgie Orthopédique, 2 avenue Oscar-Lambret, 59037 Lille, France. Correspondence should be sent to Dr G. Walch; e-mail: walch.gilles@wanadoo.fr ©2011 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.93B9. 25926 $2.00 J Bone Joint Surg Br 2011;93-B:1240–6. Received 27 September 2010; Accepted after revision 17 May 2011 Radiological changes and differences between cemented and uncemented components of Grammont reverse shoulder arthroplasties (DePuy) were analysed at a mean follow-up of 9.6 years (8 to 12). Of 122 reverse shoulder arthroplasties implanted in five shoulder centres between 1993 and 2000, a total of 68 (65 patients) were available for study. The indications for reversed shoulder arthroplasty were cuff tear arthropathy in 48 shoulders, revision of shoulder prostheses of various types in 11 and massive cuff tear in nine. The development of scapular notching, bony scapular spur formation, heterotopic ossification, glenoid and humeral radiolucencies, stem subsidence, radiological signs of stress shielding and resorption of the tuberosities were assessed on standardised true anteroposterior and axillary radiographs. A scapular notch was observed in 60 shoulders (88%) and was associated with the superolateral approach (p = 0.009). Glenoid radiolucency was present in 11 (16%), bony scapular spur and/or ossifications in 51 (75%), and subsidence of the stem and humeral radiolucency in more than three zones were present in three (8.8%) and in four (11.8%) of 34 cemented components, respectively, and in one (2.9%) and two (5.9%) of 34 uncemented components, respectively. Radiological signs of stress shielding were significantly more frequent with uncemented components (p < 0.001), as was resorption of the greater (p < 0.001) and lesser tuberosities (p = 0.009). Grammont introduced the reverse shoulder prosthesis in 1985, 1 consisting of a large hemi- spherical glenoid component without a neck and a congruent polyethylene humeral compo- nent implanted with a non-anatomical inclina- tion of 155°. In contrast to previous constrained shoulder prostheses (ball-and- socket or reverse ball-and socket), the centre of rotation was medialised to lie at the glenoid bone-prosthesis interface, to minimise torque in the glenoid component, increase the moment arm of the deltoid and theoretically protect against glenoid loosening. It also low- ers the humerus, which places the deltoid mus- cle under tension and provides a stable fulcrum for active elevation in the presence of a defi- cient unbalanced rotator cuff. Despite good functional results reported with the Grammont reverse shoulder prosthesis (DePuy International Ltd, Leeds, United Kingdom) at short- and mid-term follow-up, 2-5 complications can occur secondary to the changes in joint biomechanics produced by the design. 6 One such change, the medialisation of the centre of rotation, is responsible for impingement of the medial border of the humeral component on the scapular neck when the arm is adducted. Repetitive contact between polyethylene and bone may result in poly- ethylene wear debris, chronic inflammation and osteolysis. 7 Although numerous authors 4,8-11 have reported their personal experience of this phenomenon, the clinical and radiological evolution of scapular notching is unclear. 4,8,10 In some cases it is associated with loosening of the glenoid component, 12 but this is not always the case. Nyffeler, Werner and Gerber 9 reported that the baseplate remained stable even though the inferior half of the glenoid resorbed. Scapu- lar notching has also been associated with the presence of an inferior bone spur and ossifica- tions in the glenohumeral space. 2,8 Radiolucency around the Grammont glenoid component has been described less fre- quently and with a lower rate of loosening 12,13 than with anatomical total shoulder replace- ment (TSR). 4,5,7,14-16 Even though studies have evaluated post-operative changes to the glenoid, such as scapular notching, radiolucent lines (RLLs) and loosening, similar radio- logical assessment of the humeral side has been reported less frequently. 14 The Grammont prosthesis is a semi- constrained prosthesis where the constraints