Reverse Shoulder Replacement

For some patients who have endured long-term, chronic pain and major loss of mobility from arthritic rotator cuff tears, the Orthopaedic & Spine Institute performs minimally invasive reverse shoulder replacements.

 

“Before I injured myself, I couldn’t get my arm over my head,” Raymond continues. “Now I can do virtually anything. I’m so happy with my new shoulder.”

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This pioneering procedure has been used in Europe for approximately 20 years, but it has only been FDA-approved in the United States since 2004. The Institute is among a select number of hospitals in the country who are able to perform this complex operation.

Our orthopaedic surgeons reverse the mechanics of the shoulder, which is normally a ball (the end of the upper arm bone, or the humerus) and socket (the shoulder blade, or scapula). Using minimally invasive arthroscopic instruments, Institute surgeons implant a prosthesis that attaches the ball to the shoulder blade and the socket to the top of the arm bone.

Five-part Implant

Reverse shoulder implants consist of five components. The epiphysis, or upper portion of the humeral stem, aligns with the top of the humerus. This metal piece is made of cobalt chrome, titanium or stainless steel. The diaphysis, or bottom part of the humeral stem, is inserted into the middle of the humerus.

The epiphysis also holds the third part, a polyethylene cup that creates the socket portion of the new joint. Fourth is the metaglene, a specially coated metal plate that attaches to the scapula with screws.

The glenosphere is the fifth component. It replaces the ball portion of the shoulder joint and is a half-globe shaped metal piece that attaches to the metaglene. The glenosphere fits into the polyethylene cup on the humeral side to form the new shoulder joint. The polyethylene cup and glenosphere come in various sizes to accommodate different body sizes.

Mainly Used in Older Patients

Minimally invasive reverse shoulder replacement is mainly used for older individuals whose rotator cuff muscles (the muscles around the shoulder joint) have degenerated (called end-stage cuff arthropathy). Or, the muscles may be weakened to the degree that they can no longer hold the shoulder together or allow it to move normally in conjunction with arthritis.

The arthropathy may be the result of arthritis, a previous shoulder fracture, rotator cuff tear, and/or previous failed shoulder surgeries. It’s also used for patients who don’t have a rotator cuff (called pseudo-paralytic shoulder).

Are You a Candidate?

The procedure is especially beneficial to older patients with significant pain and little or no movement in their shoulder. Many patients see a drastic difference in their range of motion and pain due to arthritic rotator cuff tears. Many also regain the ability to perform basic living functions like combing hair, drinking from a glass, and raising the arm.

Those who have had infections, scapular deficiencies, or who do not have functioning deltoid muscles are not candidates for this procedure. The deltoid muscle is the only original muscle that remains with a reverse shoulder replacement.

The procedure usually lasts about three hours, and patients generally spend several days in the hospital. Your Institute surgeon will also prescribe a regimen of physical therapy that lasts about three months, which usually aligns with the time it takes to fully recover from the surgery. 

Call 215-481-BONE today to find an Institute orthopaedic surgeon.