Surgical Information

Reverse Total Shoulder Replacement

What is reverse total shoulder replacement?

Reverse total shoulder replacement is an exciting new surgical option for patients with severe damage or instability in their shoulder joint. In this procedure, the surgeon “reverses” the technique used in a conventional total shoulder replacement, switching the position of the ball and socket so the ball is on the socket side of the joint and the socket is on the ball side.

Afterwards, patients use their deltoid muscle, instead of their rotator cuff, to lift their arm overhead. Reverse shoulder replacement restores overhead motion, relieves pain and stiffness, and helps reestablish a functional shoulder. Candidates for this procedure include patients with advanced arthritis, unrepairable rotator cuff tears, no range of motion in the shoulder joint and severe shoulder fractures. Until recently, patients with these conditions had no solutions because the damage was too great to undergo conventional total shoulder replacement.

Anatomy

The shoulder is a ball-and-socket joint made up of three bones: the humerus (arm bone), the scapula (shoulder blade) and the clavicle (collarbone). The bones are covered with articular cartilage for smooth, pain-free motion of the joint. The muscles and tendons that surround the shoulder provide stability and support. All of these structures allow the shoulder to rotate through a greater range of motion than any other joint in the body.

Osteoarthritis and rheumatoid arthritis cause the surface layer of cartilage to wear away. Without this cushioning effect, the bones of the shoulder joint rub together. The shoulder can't move easily and becomes stiff, swollen and painful.

When is surgery recommended?

If you have debilitating shoulder pain or instability that limits your ability to perform everyday activities, you may be a candidate for a reverse total shoulder replacement.

The procedure can alleviate pain, improve motion, strength and function, and help you return to the activities you enjoy. However, the way a shoulder replacement will ultimately perform depends on a number of factors, including your age, activity level and overall health. It is important that you are thoroughly screened by an experienced orthopaedic surgeon to determine the most appropriate type of treatment.

What is the recovery time?

A careful, well-planned rehabilitation program is critical to the success of a reverse total shoulder replacement. Most patients wear a sling for three to four weeks. Gentle physical therapy begins immediately following surgery to regain range of motion and progresses to include more challenging exercises that strengthen the shoulder joint. Total rehabilitation time usually takes several months. However, as with all surgical procedures, specific recovery time varies by patient and demand.

Generally, patients are able to resume an active lifestyle, including most sports, with some restrictions on overhead activities.

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