Reverse Shoulder Replacement

Reverse Shoulder Replacement Overview

Shoulder arthritis causes pain, swelling and inflammation and is quite common in the older adult population. Arthritis can develop from a previous shoulder injury or from natural wear and tear and aging of the joint. When the cartilage of the ball and socket begins to wear away, conservative measures such as rest, ice and anti-inflammatory medications can alleviate the symptoms. In some cases, along with cartilage deterioration, the rotator cuff may tear or become dysfunctional. Alternatively, fractures or prior surgery can cause significant deformity of the normal anatomy and functional deficits. If the condition progresses and all other treatment options fail, a reverse shoulder replacement may be recommended by Dr. Brian Waterman, shoulder surgeon serving the communities Winston Salem, Greensboro, High Point, North Carolina.

Reverse shoulder replacement may be a recommended shoulder treatment for patients who have developed a complex type of shoulder arthritis called “rotator cuff tear arthropathy.” This condition occurs when the muscles that help center the ball (humeral head) in the socket (glenoid part of the shoulder blade) move higher than the socket because of long standing rotator cuff tears. A rotator cuff tear that cannot be repaired and a failed total shoulder replacement are additional shoulder injuries that can be effectively treated by this procedure.

Treatment

A traditional shoulder replacement depends on the rotator cuff muscles to keep the replacement in position and allow shoulder movement. When a patient experiences a rotator cuff tear that cannot be repaired or if the rotator cuff muscles no longer function like they should, a reverse shoulder replacement may be the best treatment option since it relies on the deltoid muscle to create movement.

A reverse shoulder replacement is much like a traditional shoulder replacement. Both techniques involve replacing the natural degenerated bone and cartilage with plastic and metal components. The components allow the shoulder to move freely and pain free. This special type of replacement surgery changes the biomechanics of the shoulder by allowing the deltoid muscle to stabilize and move the shoulder joint instead of the original rotator cuff muscles. Dr. Waterman accomplishes this by placing the ball on the glenoid (typically the socket) and the socket on the humerus (typically the ball). With the reversal of the ball and socket, a “reverse” shoulder replacement is achieved.

The procedure is approximately one to two hours and generally requires an overnight hospital stay. It is performed through a small open incision in the front of the shoulder. The implant is generally fixed in place with screws on the socket side and impacted into the canal of the bone on the humeral side. This allows provisional fixation until the bone heals to the implant resulting in long term stability.

Reverse Shoulder Replacement Recovery

Following surgery, Dr. Waterman’s team will provide the recommended amount of pain medication and antibiotics to alleviate pain and prevent infection. The arm will be placed in a sling for a predetermined amount of time. Physical therapy will begin almost immediately after the procedure. The initial therapy focuses on safe motion with certain restrictions for a specific amount of time, typically six weeks. Reverse shoulder replacement recovery is dependent on how closely a patient follows recovery guidelines. Many patients can expect a full recovery within three to four months.