Shoulder Replacement Surgery: Reverse Total Shoulder Arthroplasty
Reverse total shoulder arthroplasty is a very interesting new addition to what we do in shoulder replacement – just as if the patient has had a knee replacement, which people are familiar with, or a hip replacement. A lot of people don’t realize we do shoulder replacements. When someone in an older age group with arthritis loses the function of the rotator cuff, a standard shoulder replacement doesn’t give them funtion. It may relieve the shoulder pain but they can’t utilize the arm, they can’t lift the arm, and they don’t have motor function that makes for a good outcome.
Years ago, a French orthopedist designed a “reverse” procedure, where we literally reverse the mechanics of the shoulder. The ball becomes the cup, so to speak, and the cup becomes the ball of the shoulder. It changes the mechanics to allow other muscles to move the shoulder. It’s been a phenomenal addition to our armamentarium in the last 10 years.
Reverse total shoulder replacement treats arthritis, and in some cases, it treats a very bad rotator cuff tear. Although some patients may not have arthritis, their shoulder function is so poor that a shoulder replacement is the only way we can provide them with a functional ability to lift the arm for activities for daily living . On ocassion, we do it just because of a really bad rotator cuff tear, but in general itis a treatment for shoulder pain due to arthritis.
The ideal candidiate is an elderly patient, around 75 or older who has bad shoulder pain from arthritis. Someone who doesn’t have a very good muscle function, yet is still healthy – has no significant heart or lung problems and who we know is going to be able to utilize this prothesis well. But the reason to do it is primarily shoulder pain. I keep mentioning function, but shoulder pain relief is the primary reason to do a shoulder replacement. When shoulder pain gets severe enough that it occurs every day and night, that’s the primary reason I do reverse total shoulder replacement.
Reverse total shoulder arthroplasty is remarkable. Routinely, in two weeks they come in, they can lift the arm overhead. I occasionally do some physical therapy with them, but I don’t require it. About half the patients don’t do any physical therapy because they function so well. Reverse shoulder replacement usually requires younger patients to stay a day in the hospital, and two days for other patients, but it’s not a lot of physical therapy. The patients in the hospital are in there more for pain control. They function very well, and they function much quicker with a better outcome than a standard total shoulder arthroplasty.
I personally limit their activity for about a month. They often want to return to normal activities sooner but I limit it because tissue needs to heal in that first month. Then I routinely let them do whatever they’re capable of doing following their shoulder replacement.
I encourage them to go online and look at the reverse total shoulder arthroplasty procedure, to understand the procedure, because it’s new and we are changing mechanics of their shoulder. It’s very hard to understand; watching a video certainly helps. I also encourage them to talk to other patients who have had the reverse total shoulder arthroplasty procedure. That speaks volumes. Those people do well. They have good shoulder pain control and they have become functional again very quickly, so I really encourage patients to search out people who have had the procedure done.