Reverse Shoulder Replacement

What is Reverse Shoulder Replacement?

Anatomic total shoulder replacement is not very effective in the treatment of certain types of degenerative joint disease, most notably rotator cuff arthropathy. Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where you suffer from both shoulder arthritis and a rotator cuff tear. 

Differences between Conventional and Reverse Shoulder Replacement

Conventional shoulder replacement surgery involves replacing the ball of the humerus with a metal ball and the glenoid cavity of the shoulder blade (scapula) with a plastic socket. If this surgery is used to treat rotator cuff arthropathy, it may result in joint instability and implant loosening due to the torn rotator cuff. Therefore, a specifically designed surgery was developed called reverse total shoulder replacement to be employed in such cases. 

In reverse total shoulder replacement, the placement of the artificial components is essentially reversed. In other words, the humeral ball is placed on the glenoid surface of the shoulder blade (scapula), and the plastic socket is placed on top of the arm bone. This design makes efficient use of the deltoid muscle, the large shoulder muscle, to compensate for the torn rotator cuff.

Ideal candidates for Reverse Shoulder Replacement

Reverse total shoulder replacement may be recommended for the following conditions:

• Completely torn rotator cuff that is difficult to repair
• Presence of rotator cuff tear arthropathy
• Previous unsuccessful shoulder replacement
• History of shoulder trauma with resultant deformity and arthritis
• Severe shoulder pain and difficulty in performing overhead activities
• Continued pain despite other treatments such as rest, medications, cortisone injections and physical therapy 

Reverse Shoulder Replacement Procedure

Reverse total shoulder replacement surgery is performed under general anesthesia.

• Dr. Sellers makes an incision over the affected shoulder to expose the joint.
• The humerus is dislocated from the glenoid socket of the scapula.
• The arthritic parts of the humeral head and the socket are removed and prepared for the insertion of the artificial components.
• The artificial components include the metal ball that is screwed into the shoulder socket and the plastic cup that is cemented into the upper arm bone.
• The artificial components are fixed into place.
• The joint capsule is stitched together, the tissues are approximated and the wound is closed with sutures.

Postoperative care for Reverse Shoulder Replacement

General postoperative instructions include: 

• Take all prescribed medications as instructed.
• Undergo a gentle range of motion exercises to increase your shoulder mobility.
• Physical therapy may be recommended to strengthen the shoulder and improve flexibility.
• Avoid overhead activities for at least 6 weeks.
• Don’t push yourself up out of a chair or bed using your shoulder muscles.
• Avoid lifting heavy objects.

Risks and Complications of Reverse Shoulder Replacement

The possible risks and complications associated with reverse total shoulder replacement surgery include:

• Infection 
• Dislocation or instability of the implanted joint
• Fracture of the humerus or scapula
• Damage to nerves or blood vessels
• Blood clots (deep vein thrombosis)
• Wound irritation
• Arm length discrepancies
• Wearing out of the components