reverse shoulder replacement
has been further developed according to the motto «Evolution instead of Revolution». Find out how we have addressed current clinical challenges.
No inlay screw notching thanks to two-peg design without inferior screw. Increased impingement-free range of motion due to systematic glenosphere overhang and effective stem inclination of 147°. 1
Inversion of the materials in the tribological pairing eliminates polyethylene wear on the scapula neck and surrounding structures. 2
Proven primary treatment with more than ten years of clinical experience and convincing clinical evidence. 3,4
In case of possible hypersensitivity to metal ions, our reverse shoulder Affinis Inverse offers a standard solution for allergy patients.
Reverse Shoulder Replacement with an Evolutionary Design
Inversion of the materials in the tribological pairing eliminates polyethylene wear on the scapula neck
Inversion of the materials in the sliding coupling to a hard inlay of ceramic or metal on the humeral side eliminates polyethylene wear on the scapula neck and surrounding structures. 2 This results in a reduced risk of polyethylene-induced disorders such as osteolysis. 5,6-8
No inlay screw notching thanks to two-peg design without inferior screw
In the Metaglene DP (Double Peg), inlay screw notching was eliminated by metaglene optimisation to a two-peg design without an inferior screw.
Reduced risk of notching thanks to effective mean stem inclination of 147°
By the medial inlay chamfer of 8°, the frequently discussed mean inclination was shifted to the inlay. The original stem inclination of 155° is thus reduced by 8°. This results in an effective mean inclination of 147°, allowing increased adduction without mechanical notching in the neutral position of the humerus and generally a higher range of motion.
Increased impingement-free range of motion thanks to by-design eccentricity of the metaglene
An increased impingement-free range of motion is achieved by a systematic glenosphere overhang. The by-design eccentricity of the metaglene, together with the placement on the inferior edge of the glenoid, reduces the risk of notching.
Good primary stability and permanent secondary stability thanks to coated pegs and compression screws with locking caps
The double coating of the two Metaglene DP pegs with titanium plasma spray and a resorbable calcium phosphate compound, which accelerates osseointegration through its osteoconductive effect, contributes to good primary and lasting secondary stability. Even higher primary stability is provided by the compression screws that press the implant against the bone. In addition, once turned in, the superior screw of the Metaglene DP is eventually locked at a fixed angle with the base plate by means of a locking cap.
Minimised risk of disconnections thanks to snap-in mechanism between metaglene and glenosphere
A snap-in mechanism ensures a stable connection between metaglene and glenosphere. The snap-in fixation of the glenosphere is secured by means of a fixation screw, in order to prevent loosening of the connection between the components. Deliberately, in order to minimise the risk of infection a compact design with only two components (metaglene and glenosphere) was chosen. The rate of infection was reduced from 4.0% with earlier systems 9 to 0.7% with the Affinis Inverse prosthesis. 10
Minimised risk of infection or disconnection thanks to monolithic stems
The Affinis Inverse prosthesis convinces also on the humeral side with its evolutionary design with monolithic press-fit stems. In the same manner as for the glenosphere, the risk of infection was to be minimised by reducing the number of individual parts in the stem. 11 Connection of multiple individual components additionally entails a higher risk of disconnections. 12
The Affinis Inverse shoulder system is defined by an inverse and evolutionary implant design as well as by use of progressive materials.
These are vitamys, a highly crosslinked polyethylene enriched with vitamin E, for the glenosphere. The benefits of vitamys are obvious: The good mechanical strength allows long-term mechanical performance of the material. The high wear resistance reduces wear and thus the risk of osteolysis. 6-8 The addition of vitamin E furthermore ensures resistance to oxidation and thus high resistance to ageing as well. 13
Mathys uses high-quality ceramics for the inlay. Low wear rates, high strength and toughness, good wettability and biologically inert behaviour 5,13,14 argue for this material. These advantages make the ceramics a treatment option not only for young and active patients.
For the Affinis Inverse stems and the metaglene, the titanium alloy Ti6Al4V is used, which has proven its worth in medical technology for many years. The quality of the alloy is shown by a controlled homogeneous structure and the high strength of the material, and it permits nickel-free anchoring in the bone.
Allergic reactions to metal ions in joint replacement are an issue that concerns patients and physicians. Ceramics, titanium and PE/vitamys provide a solution for patients with hypersensitivity to nickel, cobalt, chromium and molybdenum ions. The Affinis Inverse system thus offers implants that are directly available as a standard solution for cases of hypersensitivity.
The ceramys ceramic inlay as well as the vitamys (PE) glenosphere of the Affinis Inverse prosthesis show significantly lower wear in simulator testing than UHMWPE (PE) or cobalt-chromium (CoCr) components do. The wear reduction of the optimum coupling of vitamys/ceramys compared to the coupling of CoCr/UHMWPE is 82%.15
The Affinis Inverse system offers smart instrumentation, and as a result, it allows convenient operation with simple and logical workflows for efficient installation of the prosthesis. In addition, all surgical steps are instrumentally guided. Free-hand manipulations are avoided, hence reproducible results can be achieved.
The instruments are arranged in a straightforward tray concept that ensures and simplifies overview of the entire instrumentation at all times.
Reverse shoulder prosthesis
LC system with SMarT instruments
1. Humeral resection
2. Humerus preparation and stem implantation
3. Glenoid preparation
4. Metaglene implantation
Completely instrument-guided humeral resection for the delto-pectoral and lateral access
Step-by-step preparation of the humerus for the final stem implantation
Kirschner wire-guided glenoid preparation for inferior-aligned implant placement
Eccentric implantation of the two-peg metaglene DP and fixation with A/P compression screws and fixed-angle superior screw
Affinis shoulder system
The Affinis Shoulder system covers a wide range of indications: Whether primary treatment, fracture or revision prosthesis – the prostheses solve orthopaedic challenges systematically and uncompromisingly and are defined by a sophisticated implant design as well as by use of advanced materials.
Further information about the Affinis shoulder system can be found on the Mathys website
Osteoarthritis of the shoulder
Osteoarthritis of the shoulder
Rotator defect arthropathy
Proximal humerus fracture
Proximal humerus fracture
You can learn about the reverse total shoulder implant and the surgical technique at congresses and workshops.
DKOU Congress – Mathys Symposium
Challenges and Controversies in Shoulder Arthroplasty – Challenges and possible Solutions
Affinis Inverse – Brochure
Affinis Inverse Metaglene LC System – Brochure
Affinis Inverse Metaglene DP – Surgical technique
Affinis Inverse Metaglene CP – Surgical technique
Affinis Inverse Metaglene DP – Instructions for technical surgical assistance
Affinis Inverse Metaglene CP – Instructions for technical surgical assistance
We provide you with the current version of the existing documents. Older versions of the surgical techniques, guidelines and processing instructions are listed in our overview Overview_IFU and can be requested at email@example.com.
Documents in other languages can be found on the Mathys website:
- 1 de Wilde L F, Poncet D, Middernacht B, Ekelund A. Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop. 2010;81(6):719-26.
- 2 Kohut G, Dallmann F, Irlenbusch U. Wear-induced loss of mass in reversed total shoulder arthroplasty with conventional and inverted bearing materials. J Biomech. 2012;45(3):469-73.
- 3 ODEP Rating: http://www.odep.org.uk/products.aspx, last access 29.10.2020.
- 4 Irlenbusch U, Kaab M, Kohut G, Proust J, Reuther F, Joudet T. Reversed shoulder arthroplasty with inversed bearing materials: 2-year clinical and radiographic results in 101 patients. Arch Orthop Trauma Surg. 2015;135(2):161-9.
- 5 Alexander J J, Bell S N, Coghlan J, Lerf R, Dallmann F. The effect of vitamin E-enhanced cross-linked polyethylene on wear in shoulder arthroplasty-a wear simulator study. J Shoulder Elbow Surg. 2019;28(9):1771-1778.
- 6 Boileau P, Moineau G, Morin-Salvo N, Avidor C, Godeneche A, Levigne C, Baba M, Walch G. Metal-backed glenoid implant with polyethylene insert is not a viable long-term therapeutic option. J Shoulder Elbow Surg. 2015;24(10):1534-43.
- 7 Harris W H. Wear and periprosthetic osteolysis: the problem. Clin Orthop Relat Res. 2001(393):66-70.
- 8 Huang C H, Lu Y C, Chang T K, Hsiao I L, Su Y C, Yeh S T, Fang H W, Huang C H. In vivo biological response to highly cross-linked and vitamin e-doped polyethylene--a particle-Induced osteolysis animal study. J Biomed Mater Res B Appl Biomater. 2016;104(3):561-7.
- 9 Wall B, Nove-Josserand L, O'Connor D P, Edwards T B, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89(7):1476-85.
- 10 National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR). Summary Report SP Humeral Affinis Inverse (Reverse Total) 23-11-20. Data valid to 21 March 2021.
- 11 Walter G, Gramlich Y. Periprothetische InfektionenInfektionperiprothetische. In: Orthopädie und Unfallchirurgie. Springer Berlin Heidelberg. ISBN 978-3-642-54673-0. 2019;1-25.
- 12 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2020 Annual Report, Adelaide; AOA, 2020: 1-474. [Accessed from: https://aoanjrr.sahmri.com/annual-reports-2020]. Table ST48, page 368.
- 13 Willmann G. Improving Bearing Surfaces of Artificial Joints. Advanced Engineering Materials. 2001;2(3):135-41.
- 14 Barnes D H, Moavenian A, Sharma A, Best S M. Biocompatibility of Ceramics. ASM Handbook. 2012;23.
- 15 Lerf R, Wuttke V, Reimelt I, Dallmann F, Delfosse D. Tribological Behaviour of the “Reverse” Inverse Shoulder Prosthesis. 7th International UHMWPE Meeting. Philadelphia 2015.