Reverse Shoulder Surgery
The reverse shoulder replacement is designed for patients who do not have a functioning rotator cuff, and therefore do not have "normal" shoulder anatomy.
The rotator cuff is the group of tendons and muscles that surround the shoulder joint. These muscles and tendons are important in performing shoulder tasks (such as lifting your arm overhead), and keeping the ball of the ball-and-socket shoulder joint centered.
The reverse shoulder replacement was specifically designed for a problem called rotator cuff tear arthropathy. Rotator cuff tear arthropathy is a problem that occurs when a patient has both shoulder arthritis and a rotator cuff tear. When the rotator cuff is torn, the shoulder can wear out, leading to shoulder arthritis.
The reason that the reverse shoulder replacement was developed is due to the fact that traditional surgical options for shoulder arthritis do not work well when patients also have a rotator cuff tear. In these patients, total shoulder replacements often do not work. In a traditional shoulder replacement, the ball of the top of the arm bone (the humerus) is replaced with a metal ball. The socket of the shoulder blade (scapula), is replaced with a plastic socket. In patients who have this total shoulder replacement and also have a torn rotator cuff, the socket of the implant is prone to loosening. The absence of a rotator cuff causes the implant to move abnormally, and cause unusual forces on the socket.
What is the Reverse Shoulder Replacement
A traditional shoulder replacement uses a metal ball on the top of the arm bone, and a plastic socket on the shoulder blade.
This is similar to how our body is designed with a ball-and-socket shoulder joint.
The reverse shoulder replacement uses a ball-and- socket joint as well, but the ball is placed on the shoulder blade, and the socket is placed on top of the arm bone. It is the reverse of our normal anatomy, and thus the name "reverse shoulder replacement."
Why Create a 'Backwards' Shoulder?
A reverse shoulder replacement is designed to make the deltoid muscle, the large shoulder muscle, more efficient. In patients with rotator cuff tear arthropathy, the rotator cuff does not work normally, and the deltoid can help make up for this deficiency. By reversing the ball and the socket, the deltoid muscle becomes more able to lift the arm up overhead, and compensate for the torn rotator cuff.
Is it the Right Option?
Patients interested in a reverse shoulder replacement must have severe shoulder arthritis, and a chronic rotator cuff tear. Other factors that influence the decision to perform a reverse shoulder replacement include the function of the deltoid muscle (that must be working well), the age of the patient, and the functional demands of the patient.
In general, reverse shoulder replacements are designed for patients with limited activity demands.
The Reverse Shoulder procedure should only be done by a qualified surgeon who has extensive training and experience. Dr. Hayter has the experience and training that is important to the success of your shoulder surgery. You and Dr. Hayter can discuss your options and make the best decision for you.