Reverse Total Shoulder Replacement

Total shoulder replacement surgery has been traditionally performed for those patient who have a condition related to advanced osteoarthritis, rheumatoid arthritis, avascular necrosis, or for certain fractures of the humerus. The rotator cuff in conjunction with the surrounding muscles helps elevate the arm. The rotator cuff is susceptible to tears and chronic wear which can lead to significant pain and loss of mobility. For this subset of patients, there is no support to hold a traditional shoulder replacement in place and allow for motion.

Introduced over ten years ago in the U.S. was reverse total shoulder replacement surgery. This allows patients who have a rotator cuff tear that cannot be repaired, those with a rotator cuff arthropathy, or those who have had prior unsuccessful total shoulder replacement, the opportunity to alleviate pain, restore overhead motion and functional ability.

In a reverse total shoulder replacement, the metal ball is placed in socket and the polyethylene cup (plastic) is placed at the upper end of the humerus. This is in contrast to a traditional shoulder replacement where the components are reversed. Since the rotator cuff muscles are often dysfunctional in a patient who undergoes this type of surgery, the deltoid muscle becomes the primary mover of the arm.

Reverse total shoulder replacement is technically a complex procedure that is performed by a highly trained orthopaedist in a hospital setting. This surgery can take up to a few hours to perform and is intended for relatively healthy individuals with good bone quality. General anesthesia with a nerve block is commonly used.

Full recovery can take several months. Patients who undergo this type of procedure are usual advised to avoid heavy lifting and high impact activities.

As with any surgical procedure, there are risks that must be considered. Infection, fracture, injury to nerves and blood vessels, blood clots, shoulder dislocation, and loosening of the prosthesis are some of the potential risks. Outcomes from this time of surgery do vary from patient to patient.