Traditionally, total shoulder replacement is performed for patients who have shoulder arthritis and have failed non-surgical treatment. The rotator cuff is involved in helping the surrounding muscles to elevate the arm when needed. In some cases, the rotator cuff can develop chronic wear or even become completely torn (rotator cuff arthropathy) which can cause significant pain and prevent normal function of the shoulder. For these patients, total shoulder replacement may not be an option since the possibility of continued pain and limited mobility exists.
Over ten years ago, reverse total shoulder replacement surgery was reintroduced in the U.S after considerable improvement. This allows patients who have a rotator cuff tear that cannot be repaired, those with a rotator cuff arthropathy, or those who have had prior unsuccessful total shoulder replacement, the opportunity to alleviate pain, restore overhead motion and functional ability.
When total shoulder replacement is performed, a plastic cup is placed in the shoulder socket and a metal ball is placed at the end of the upper arm bone (humerus). In a reverse total shoulder replacement, the components are switched. The metal ball is placed in the socket and the plastic cup is placed at the upper end of the humerus. Since the rotator cuff muscles do not work properly in someone who has a reverse total shoulder replacement, the deltoid muscle becomes the primary mover of the upper arm.
Reverse total shoulder replacement is technically a complex procedure that is performed by a trained orthopaedist. This surgery is intended for relatively healthy individuals with good bone quality. Outcomes from this time of surgery do vary from patient to patient.
This procedure is normally performed in a hospital setting and make take up to a few hours to perform. Patients may spend up to a few days in the hospital following surgery.
As with any surgical procedure, there are risks that must be considered. Infection, fracture, injury to nerves and blood vessels, blood clots, shoulder dislocation, and loosening of the prosthesis are some of the potential risks. Outcomes from this time of surgery do vary from patient to patient.