What is a Reverse Total Shoulder Replacement?
Author: John G. Costouros, MD
The shoulder is the most complex joint in the human body. The dynamic interplay
of bones, muscles and tendons, while allowing for greatest range of motion
of any joint in the human body, also makes it uniquely susceptible to
injury. Over time, the pain and diminished motion that these types of
injuries cause can seriously affect one’s quality of life.
While many shoulder issues can be treated with nonsurgical methods like
medications, physical therapy or injections, shoulder surgeries are increasingly
common and able to provide predictable outcomes and durable results. In
fact, there are many procedures available that use arthroscopic techniques
in which a small incision is made and a tiny high-definition camera is
used with specialized instruments to guide the surgeon through minimally-invasive
surgery. Because they’re less invasive, there’s typically
less postoperative pain and bleeding, more cosmetic incisions which are
barely visible, shorter surgical times, lower risk of infection, and faster
recovery. These are also outpatient procedures, allowing patients to go
home on the same day as surgery.
However, when a shoulder joint has degenerated to the point it needs to
be replaced, patients can opt for a total shoulder replacement or reverse
total shoulder replacement.
What’s the Difference?
While both the total shoulder replacement and reverse total shoulder replacement
involve replacing the surfaces of the shoulder joint with prosthetic components
made of metal and plastic, the difference is how these prostheses are
Your shoulder joint consists of a ball and socket. The ball (or humeral
head) is part of your arm bone (humerus), and rests in the socket portion
of your shoulder blade (glenoid). With a reverse prosthesis, the ball
is placed on the shoulder blade side of your joint, while the socket is
on the arm side – a reversal of your normal anatomy. This changes
the mechanics of the shoulder and allows the deltoid muscle to power the
arm overhead. Reverse shoulder replacement concept has been used successfully
around the world for over 30 years and was FDA-approved for use in the
United States in 2004.
Why Get a Reverse Total Shoulder Replacement?
Sometimes, the muscles and tendons of the rotator cuff within the shoulder
are so damaged that a standard total shoulder replacement won’t
perform well. This can lead to poor motion and loosening of the components.
When these tendons are torn to the point they no longer attach to bone,
a person will be unable to lift their arm overhead, out to the side, or
reach behind their back. This adversely affects quality of life.
Because it doesn’t rely on the tendons and muscles of the rotator
cuff, a reverse prosthesis offers the best chance of restoring use of
the arm and range of motion.
What is the Surgery Experience?
Surgery and recovery time depend largely on whether it’s the first
shoulder replacement (primary) or if there is an existing prosthesis that
needs to be removed and replaced (revision).
For all shoulder procedures, a nerve block is done followed by a general
anesthetic. An incision is made in the front of the shoulder through which
the deteriorated shoulder joint is removed. Typically, this type of procedure
takes less than an hour in the hands of an experienced shoulder specialist.
While a patient may begin some elbow, wrist, and hand motion immediately
following surgery, movement of the shoulder may be limited for a few days
to a few weeks. Physical therapy is a crucial part of obtaining the best
possible outcome following shoulder replacement surgery. Relief of pain
is rapid following shoulder replacement and return of range of motion
is more gradual as patients progress through their formal physical therapy
Reverse Total Shoulder Replacement at the IJRR
As one of the first surgeons to bring reverse shoulder replacement to the
U.S., I’ve seen how this procedure can change lives and treat a
wide spectrum of complex shoulder problems. Now, 16 years later, I’ve
had the privilege of participating in several clinical trials to refine
this and other shoulder procedures, as well as helped with the development
of better prostheses and implants that are currently in use.
I decided to join Washington Hospital’s
Institute for Joint Restoration and Research in order to bring shoulder joint replacement surgery to a place that has
set the bar so high for patient outcomes and quality of care. I wanted
my skills and expertise to be part of that. Building on the successes
of the hip and knee replacement specialties pioneered at the IJRR, we’re
now able to add total shoulder replacement and reverse total shoulder
replacement to our advanced surgical offerings.
Learn more about how education and specialization are improving quality
of life for our patients, with
this video on the Institute for Joint Restoration and Research.
Posted March, 2020