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Shoulder Procedures - Reverse Total Shoulder Replacement

Reverse total shoulder replacement is a newer procedure specifically for people who have experienced a massive non-repairable rotator cuff tear; people with large rotator cuff tears who have developed a painful type of shoulder arthritis called cuff tear arthropathy; people with a previous shoulder replacement that was unsuccessful; and/or for people who have exhausted all other treatment options.

The procedure was first developed in Europe during the 1960s but unfortunately was met with complications due to poor fixation methods. In 1992, Dr. Grammont improved on prior failures with a newer device with better fixation that resulted in significantly improved outcomes. In 2003, the FDA approved its use in the United States. Early results among U.S. surgeons have been encouraging, but it’s a more complex procedure than a standard total shoulder replacement and it’s vital to select a surgeon experienced in reverse total shoulder replacement.

How is it different that a standard shoulder replacement?

The human shoulder is a ball and socket joint. The “ball” is the humerus, and it nests and rotates within the glenoid or “socket.” In a standard shoulder replacement artificial components replace the humerus and the glenoid, but the basic function remains the same—the humerus is the ball and the glenoid is the socket. As the name suggests, a reverse total shoulder replacement creates the opposite interaction between the two bones. Essentially, the humerus is modified to become the socket and the glenoid is modified to become the ball.

Why reverse the two functions?

In a standard total replacement, the rotator cuff muscles are essential to returning the shoulder to normal function and stability of the artificial parts. For someone with a large rotator cuff tear or cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement works by making the deltoid muscle more efficient allowing it to substitute for the torn tendons that are not able to work.

What happens during the procedure?

The surgeon makes an incision into the shoulder and frees the head of the humerus from the socket, then the head of the humerus and removed. The upper portion of the humerus is then hollowed out to receive the socket implant.

The metal socket implant is inserted and secured into the top of the humerus and then a plastic (polyethylene) socket cup is attached to the top of the implant. The glenoid (socket) is then reshaped, creating a stable flat surface to attach the metal ball component. The base of the ball component is anchored firmly with screws and the ball is then pressed into place thru a Morse taper.

The video below provides a step by step look at the procedure.

What is the recovery like?

People who have had a reverse total shoulder replacement typically spend one day in the hospital after the surgery. Before leaving the hospital, a physical or occupational therapist will establish a personalized recovery plan.

Physical therapy will focus on gradually increasing range of motion and shoulder strength. This will probably first take place in a therapist’s office or during a home visit by the therapist. This process typically takes between six to eight weeks. As the shoulder strengthens and range of motion increases, home exercises will be identified to help the shoulder return to day-to-day activities. Average recovery is typically 4-6 months. Functional results will improve for 1-2 years post surgery.

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