What is Reverse Shoulder Arthroplasty?

Advances in orthopedic surgery have changed the lives of patients with the severest rotator cuff injuries.  Reverse shoulder arthroplasty can restore overhead motion, alleviate pain, and create a functioning shoulder for these individuals.  Getting a basic idea of how the procedure works and what to expect helps put many patients at ease.

Rotator Cuff Basics

The shoulder joint consists of a ball and a socket.  The ball is the top of the upper arm bone (humerus) and fits into a socket in the shoulder blade.  The rotator cuff’s function is keeping the arm in the shoulder socket.

A rotator cuff is actually a group of four muscles that form tendons and create a covering around the head of the humerus.  It attaches this bone to the shoulder blade, making it possible to rotate and lift an arm.

Pain occurs when the tendon fails to attach to the top of the humerus.  It might start as tendon fraying.  As damage increases, a partial or a full tear could result.  An acute injury or a degenerative condition like arthritis or repetitive use might be the culprit.

Rotator cuff tears are a common source of pain among adult patients.  Around 2 million Americans see a physician every year because of related issues.

The goal of treatment is reducing pain and restoring shoulder function.  For around half of those with rotator cuff problems, nonsurgical steps can accomplish these objectives.  However, nonsurgical treatments often do not cause an improvement in shoulder strength. The tear could also increase in size as time passes.

Rotator Cuff Surgery Candidates

Signs that surgery is the best option include:

  • Symptoms have persisted for 6 to 12 months.
  • The tear is larger than 3 cm.
  • There is notable weakness and function loss in the shoulder.
  • The tear is a result of a recent and acute injury.

Most rotator cuff surgeries reattach the tendon to the top of the humerus.  Orthopedic surgeons have a number of options for doing this.

However, for individuals who have experienced a massive tear that cannot be repaired with traditional surgery, reverse shoulder arthroplasty—also known as reverse shoulder replacement—is the only option.

These patients typically suffer damage caused by a complex kind of arthritis in the shoulder joint and can’t lift their arms to shoulder height.  Standard surgery for could result in limited motion and pain.  Reverse surgery can restore overhead motion, eliminate pain, and recreate a functional shoulder.

The Reverse Procedure

Reverse shoulder arthroplasty gets its name from the reversal of the positions of the prosthetic ball and socket used during the procedure.  This inpatient procedure originated in Europe in the 1980s and was approved by the U.S. Food and Drug Administration (FDA) in 2003.

In a traditional shoulder replacement, the physician fits a plastic cuplike device into the shoulder socket and attaches a metal ball to the top of the humerus.  During a reverse procedure, the ball attaches to the socket, while the cup is placed on the top end of the humerus.

An orthopedic surgeon might recommend this procedure for patients who:

  • Suffer from a rotator cuff that is completely torn and can’t be repaired
  • Have cuff tear arthropathy
  • Underwent a previously unsuccessful shoulder replacement
  • Have trouble lifting an arm away from their side or over their head and experience severe shoulder pain
  • Have tried non-surgical options like cortisone injections, rest, and physical therapy

The reverse procedure is particularly effective for patients with cuff tear arthropathy from arthritis since it uses different muscles for arm movement.  It relies on the deltoid muscle to position and power the affected arm instead of on the damaged rotator cuff.

A reverse shoulder arthroplasty takes about two hours.  The incision is placed on the front or top of the shoulder.  After removing the damaged bone, the physician positions the prosthetic components to restore shoulder function.

The risks associated with a total joint replacement are wear, component dislocation, or loosening.  Any of these might require repeat surgery.

Most patients are able to get out of bed the day following surgery and to return home after two or three days with a specific list of care instructions.  They are usually able to eat, self-groom, and get dressed within a few weeks.