Reverse Shoulder Replacement

Reverse shoulder replacement, also known as reverse total shoulder arthroplasty (RTSA), is a surgical procedure used to treat severe shoulder arthritis, rotator cuff tears, or other complex shoulder joint conditions. In this procedure, the normal anatomy of the shoulder joint is reversed. The ball-and-socket structure is switched, with a metal ball being placed on the shoulder blade (scapula) and a plastic socket implanted at the top of the arm bone (humerus).

This reversal changes the mechanics of the shoulder, allowing the deltoid muscle (rather than the damaged rotator cuff) to take over the lifting and movement functions of the arm.

Why is Reverse Shoulder Replacement Needed?

Reverse shoulder replacement is typically performed when:

• The rotator cuff tendons are severely torn or damaged beyond repair (rotator cuff arthropathy).
• There is severe arthritis in the shoulder joint, leading to chronic pain and limited mobility.
• A previous shoulder replacement has failed.
• There are complex shoulder fractures that can't be repaired with other treatments.

Benefits of Reverse Shoulder Replacement

• Improved Stability: By reversing the joint structure, the deltoid muscle can compensate for the loss of the rotator cuff, leading to better stability and range of motion.
• Pain Relief: Most patients experience significant pain reduction after surgery.
• Restored Function: The procedure helps restore shoulder function, allowing patients to perform daily activities that were previously limited by pain or weakness.
• Effective for Severe Damage: It is especially effective for patients with severe rotator cuff damage, which makes them unsuitable for traditional shoulder replacement surgery.

Procedure

In reverse shoulder replacement

• The surgeon removes the damaged parts of the shoulder joint.
• The ball is attached to the shoulder blade (glenoid), and the socket is placed on the upper arm bone (humerus).
• The joint is then reassembled in this reversed configuration, allowing the deltoid muscle to control arm movement.

• The procedure generally takes 1-2 hours and is done under general anesthesia.

Recovery After Reverse Shoulder Replacement

• Hospital Stay: Most patients stay in the hospital for 1-2 days.
• Immobilization: A sling is worn for several weeks to protect the shoulder and allow healing.
• Physical Therapy: Rehabilitation begins shortly after surgery, with a focus on restoring movement and strength in the shoulder.
• Return to Activities: Light activities can usually be resumed after a few weeks, but full recovery may take 4-6 months.

Risks and Complications

• Infection: Like any surgery, there is a risk of infection.
• Dislocation: Although less common with reverse shoulder replacement, dislocation of the joint can occur.
• Nerve Damage: There is a risk of nerve injury during surgery.
• Wear and Tear: Over time, the prosthetic joint may wear down, potentially requiring revision surgery.

Longevity

Reverse shoulder replacements typically last 10-15 years or longer, depending on the patient's activity level and the condition of the shoulder joint.

Reverse shoulder replacement is a highly effective treatment for patients with severe shoulder damage, providing pain relief, increased mobility, and improved quality of life. It is particularly beneficial for those who cannot undergo traditional shoulder replacement due to rotator cuff damage.