Reverse Total Shoulder Replacement

Reverse Total Shoulder Replacement is a surgery performed to improve shoulder function and decrease pain. This procedure is performed on patients who have suffered massive rotator cuff tears, which have led to a painful condition known as rotator cuff tear arthropathy, or on those patients who have undergone previously failed shoulder surgeries. The surgery removes damaged portions of the shoulder joint, and replaces them with a prosthesis.

Anatomy

There are three bones that are involved in the shoulder: the humerus, the scapula, and the clavicle. The head of the humerus rests in the socket of the scapula called the glenoid cavity. The rotator cuff is made up of a group of four tendons from muscles that surround the shoulder joint, and together with the deltoid muscle, they work to stabilize the joint and move the arm.

Reverse Total Shoulder Replacement vs. Conventional Shoulder Replacement

There are two types of total shoulder replacement surgery: conventional shoulder replacement and reverse shoulder replacement. The determination between which surgery should be performed is based upon the strength and functionality of the rotator cuff. For many patients, the function of the rotator cuff has been compromised through massive tears, and the muscles and tendons do not function properly. In these cases, a conventional shoulder replacement may not be effective and reverse shoulder replacement may be an option. In a reverse shoulder replacement prosthesis, the ball is placed on the shoulder socket while a cup and stem replace the head of the humerus. This configuration relies on the deltoid muscle instead of the rotator cuff to stabilize the shoulder and provide joint mobility. Additionally, this procedure may be recommended for individuals who have undergone previously unsuccessful conventional shoulder replacement surgery.

Procedure

Depending upon your preference and that of the anesthesiologist, you will be put under general anesthesia and/or a nerve block. Your surgeon will make a single incision through the skin to access the shoulder joint. Your arm is rotated and the head of the humerus is removed. Next, a space is created in the humerus and your surgeon will insert the stem portion of the prosthesis into the bone. The plastic cup then is fitted onto the humeral side. Next, your surgeon will remove the damaged surface of the glenoid cavity. The first portion of the prosthesis is placed in the glenoid cavity and secured to the bone with screws. Next, the “ball” portion of the implant is affixed to the previously placed glenoid prosthesis, and the arm is rotated to place the ball into the socket. The incision is closed with internal sutures; and either external sutures, or staples. Finally, surgical tape or bandages will be placed over the incision.

Recovery and Results

End of Procedure

The ends of the donor meniscus are anchored into the holes in the tibia and sutured in place. The sutures may be tied together at the front of the shinbone (tibia), or they may be fastened to a special type of screw or button. Next, additional sutures are affixed along the margin of the meniscus to hold it in place. One or more additional small incisions may be needed for placing and tying these sutures. Once the allograft meniscus is attached, the surgical instruments are removed, the incisions are closed, and the procedure is completed. Following physical therapy as part of recovery, your knee will experience considerable pain relief.