Reverse Shoulder Replacement

What is Reverse Shoulder Replacement?

Conventional surgical methods, such as total shoulder joint replacement, are ineffective in treating rotator cuff arthropathy. Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, 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 humerus ball with a metal ball and the shoulder blade’s glenoid cavity (scapula) with a plastic socket. If this surgery treats rotator cuff arthropathy, it may result in implant loosening due to the torn rotator cuff. Therefore, a specifically designed surgery called reverse total shoulder replacement was developed 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 in the shoulder blade’s glenoid cavity (scapula), and the plastic socket is placed on top of the arm bone. This design efficiently uses the deltoid and large shoulder muscles 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
• 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.

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

Postoperative care for Reverse Shoulder Replacement

You can get out of bed on the same day of the surgery but will usually have to stay in the hospital for 1-2 days. General postoperative instructions include:

• Take all prescribed medications as instructed.
• Undergo gentle range of motion exercises to increase your shoulder mobility.
• Physical therapy will be recommended to strengthen the shoulder and improve flexibility.
• Avoid overhead activities for at least 6 weeks.
• Don’t push yourself 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 the following:

• 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