Reverse Shoulder Replacement
Reverse shoulder replacement is an alternative surgery for patients who have torn their rotator cuffs and have developed severe arthritis or who have had a previous total shoulder replacement that has failed to relieve their pain. Rotator cuff is the group of four tendons that join the head of the humerus (arm bone) to the deeper muscles and provides stability and mobility to the shoulder joint.
Reverse shoulder replacement is usually performed when two conditions occur together: 1) the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, or avascular necrosis and 2) the rotator cuff is severely torn. Reverse replacement is also considered for the patient who has a failed former shoulder replacement surgery or has fractured their humerus.
The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis). An MRI is often obtained to determine the condition of the rotator cuff.
The surgery is done under regional or general anesthesia. An incision is made over the affected shoulder to expose the shoulder joint. In a standard shoulder replacement normal procedure, a metal ball is placed at end of upper arm bone and the socket into the shoulder bone. However, in a reverse shoulder replacement, the metal ball is attached to the shoulder bone and the socket is placed at the end of the upper arm bone. By switching the prosthetics, the patient will now be able to use their deltoid muscle, instead of the torn rotator cuff, to lift and rotate their arm. After the artificial components are implanted the joint capsule is stitched and the wound is closed. Patients typically spend one night in the hospital to ensure recovery from surgery.
Risks and Complications
Possible risks and complications specific to shoulder joint replacement surgery include:
- Infection around an implanted joint
- Dislocation or instability of an 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 of the joints
- Scar formation