By Shannon M. Wolfe, MD
So what is “reverse total shoulder replacement?” This surgical device and procedure has created some confusion in the community … even the name is a little confusing. I hope this article will help clarify the procedure or at the very least, help you understand if you might be a candidate for a reverse total shoulder replacement (also called reverse total shoulder arthroplasty) for your “chronic” shoulder pain.
As always when something can be confusing, let’s first understand the problem. Many people with shoulder pain have some concern about their “rotator cuff.” The rotator cuff is a group of four tendons which come together and attach at the shoulder. These tendons act with synchrony to provide range of motion to the shoulder. Because the shoulder has such a large range of motion, the rotator cuff is susceptible to injury and tearing. Ironically, this tearing is seldom due to a “one time” traumatic event. Instead, the tendon can slowly tear over several years or even decades, until enough tearing has occurred to finally cause pain. It is this slow deterioration which complicates the “surgical repairing” of these tendons. I like to use this analogy in my office: it is hard to nail a board to your deck if that board has been weathered through time. The same applies to repairing the rotator cuff which has often undergone significant degeneration through time.
Patients may wonder if they need a total shoulder replacement in this circumstance. The answer is no. Total shoulder replacement (which I like to refer to as “traditional” total shoulder replacement) is a procedure for arthritis, which is a joint problem, not a rotator cuff tendon problem. In fact, NO rotator problems is a prerequisite for total shoulder replacement.
There is a solution for some patients who develop significant rotator cuff problems and pain. Problems could include: failure to heal a rotator cuff tear after surgery, massive rotator cuff tears which cannot be fixed or even worse, massive rotator cuff tears along with arthritis. These shoulder ailments cause pain and almost always, lack of power with movement. These are the conditions a reverse total shoulder replacement may help. (Please know that not all patients with these issues are candidates for this procedure.)
Let’s now discuss the device. The reverse total shoulder replacement is actually not new. There have been many types in the last five decades. Many of the original designs were developed in Europe and unfortunately, they failed. Over the past 20 years, there has been a resurgence of this device with new design changes. Championed in France, these new designs have significantly improved the results to the point where our FDA has approved this technique. I was fortunate to be invited to participate with a clinical design team for a reverse total shoulder replacement system. This team was created to help in the design of instruments and to improve techniques through the infancy of this procedure. I was also fortunate to perform this surgery in France with the lead design surgeon of this device. The name of this procedure is descriptive to the device. With traditional total shoulder replacement, the ball and socket of the joint are replaced. Reverse total shoulder replacement replaces the ball and socket but reverses the ball and socket orientation. Remember, this is a procedure done because the rotator cuff is not functioning. By reversing the ball and socket, we can mechanically “fool” the shoulder which allows for improved function and pain control.
This procedure typically requires a 1-2 day stay in the hospital. Contrary to rotator cuff repair surgery where you have to be careful with too much movement during the early recovery, we recommend early range of motion. Since I also perform rotator cuff repair surgery, I can tell you that recovery for reverse total shoulder replacement is actually faster than rotator cuff repair. The procedure requires 2-3 months of physical therapy as well as a home exercise program for about 6 months after the surgery.
I hope this article is helpful. If you are suffering from shoulder pain and/or have questions about this procedure, I will be happy to see you in my office for an evaluation.
Schedule an appointment with Tuckahoe Orthopaedics today to talk about ways we can help.