Reverse Total Shoulder Replacement

Reverse Total Shoulder Replacement

What is a Reverse Shoulder Replacement?

Reverse Total Shoulder Replacement (RTSR) is so named since the “ball” of the new shoulder is placed where the socket is typically located in the native shoulder.  Likewise, the “socket” of the new shoulder is precision bored where the ball of the native shoulder was. This allows the joint to function in situations where the rotator cuff is badly damaged.

Why would I get a Reverse Shoulder replacement instead of a standard replacement?

Shoulder replacement comes in two broad forms: Anatomic and Reverse.  Reverse shoulder replacement is used when the arthritis is accompanied by significant damage or disease involving the rotator cuff.  While anatomic shoulder replacement is successful in achieving pain relief in these situations, reverse replacement is a better option to maintain excellent function and provide longevity in situations involving rotator cuff damage. RTSR has proven so successful, it may also be the recommendation for patients who may not have severe arthritis but have a severe rotator cuff tear that has either failed repair or is too badly damaged for repair. 

Prior to 2004 there was not a good surgical solution for patients with arthritic shoulders and rotator cuff damage.  Reverse Total Shoulder Replacement has been one of the major developments in orthopedics so far this century and has revolutionized shoulder surgery.

Is one type of replacement better than the other?

Both Anatomic and Reverse shoulder replacement are highly successful.  Anatomic allows for slightly more internal rotation (movement of the arm behind the back)–but only in patients with a healthy rotator cuff.  RTSR is used for patients with an unhealthy rotator cuff–in these patients anatomic replacement provides pain relief but very little motion above the head or away from the body whereas RTSR provides both pain relief and excellent mobility.  

What are my options for arthritis and rotator cuff problems besides replacement?

Combined shoulder arthritis and rotator cuff disease can be managed (though not cured) with nonsurgical methods initially. Physical therapy can be helpful in selected instances but typically, activity modification (rest) and anti-inflammatory medication (oral or injected) can minimize symptoms for months to years.  In select patients, platelet-rich plasma (PRP) or stem cell therapy can be effective.  When the disease begins to interfere with everyday life and function, shoulder replacement surgery is a highly successful option.  Shoulder replacement is less common than that of the hip and knee since we don’t use our arms for walking; however, replacement of the shoulder is considered to be the most successful joint replacement in orthopedics.  

What does the surgery and recovery involve?

RTSR is performed in less than an hour and MCO is performing a large percentage of these on an outpatient basis due to the minimal pain we have observed using our muscle-sparing technique.  A sling is worn for 2 weeks after RTSR and approximately a month of physical therapy is recommended.  Pain relief and performance are very similar to anatomic shoulder replacement and similar activities, including golf, tennis and swimming, are permissible after reverse shoulder replacement.

Drs. Silas and Bak have extensive experience in shoulder replacement as Motor City Orthopedics is one of the highest-volume shoulder replacement centers in Michigan.