In a reverse total shoulder replacement, the normal anatomic configuration of the shoulder is reversed to put the ball where the socket was and socket where the ball was. These procedures are most often done for patients whose rotator cuffs are damaged beyond repair and/or are unable lift their arm overhead due to rotator cuff deficiency. Reversing the ball and socket changes the center of rotation for the shoulder, which allows the deltoid muscle to play a bigger role in moving the arm.
The Food and Drug Administration (FDA) approved the procedure in the United States in 2004, although it had been used in Europe for approximately 20 years prior. When Dr. Betsy Nolan completed her shoulder and elbow fellowship in Switzerland under Dr. Christian Gerber, her training included hundreds of reverse total shoulder replacements with one of the early adopters and design surgeons for the reverse (also called inverse) shoulder replacement.
Dr. Nolan calls the reverse total shoulder replacement the single biggest technological advance in shoulder surgery in her lifetime. The procedure is now done for many patients who previously would have been told that nothing else could be done. While it is a newer procedure than the total anatomic shoulder replacement, it is not a better treatment — the two are simply different procedures used in different situations. In recent years, new convertible implants are available which make it easier to convert an anatomic total shoulder to a reverse total shoulder at a later date, if further injury or passage of time results in new rotator cuff pathology, which requires revision.
Many patients who need a reverse total shoulder replacement will have pseudo-paralysis of the shoulder that prevents them from lifting their shoulder above 90 degrees. This means they can’t reach the top of their head to wash or groom their hair or their mouth to feed themselves, for example. Not all patients experience shoulder pain, so the issue may be written off as a nerve injury or simply old age, when in fact it’s due to a massive rotator cuff tear that occurred over time. Patients may have adjusted to limited shoulder function on one side, and it’s not until the second shoulder begins bothering them that they seek treatment. A reverse total shoulder replacement is also done for patients with arthritis when the rotator cuff is not intact and for many patients who need a revision (repeat surgery) who have undergone a prior anatomic total shoulder replacement.
Compared to anatomic total shoulder replacement surgery, the reverse total shoulder replacement is similar in terms of size of incision, length of surgery, and timeframe for recovery. The primary difference between the two are precautions to avoid dislocating the joint following surgery. An anatomic shoulder replacement can dislocate in abduction and external rotation (the position of throwing a ball overhead, for example). A reverse total shoulder replacement is most likely to dislocate in adduction and internal rotation, such as if reaching for a wallet in the back pocket.
The goal for any shoulder replacement surgery is to allow the patient to perform activities of daily life. Shoulder replacements are not designed for heavy lifting or competitive athletics, as doctors do not know how long the replacement joints will last with that level of activity. Any patient with a shoulder replacement should avoid activities with a high risk of falling, such as riding a horse, riding a motorcycle, or working on a roof.
If your shoulder motion, strength, or pain limit you from doing your normal daily activities or you have other shoulder or elbow concerns, call the Oklahoma Shoulder Center today at 405.278.8006 to schedule an appointment.