Reverse total shoulder arthroplasty is a type of shoulder replacement that is most often recommended for patients with shoulder arthritis complicated by a massive, irreparable rotator cuff tear. This procedure can also be an effective treatment for other challenging shoulder conditions, such as complex fractures. By reversing the normal anatomy of the shoulder, this innovative procedure allows patients to use the deltoid muscle to lift the arm, bypassing the damaged rotator cuff tendons. This can lead to pain relief and improved function, helping patients to return to their daily activities with greater ease.

• Reverse total shoulder arthroplasty is a surgical procedure that replaces a damaged shoulder joint, but in a “reversed” manner compared to a traditional shoulder replacement.
• By reversing the anatomy, the procedure allows the powerful deltoid muscle to take over the function of the damaged rotator cuff, enabling the patient to lift their arm and regain function.
• This procedure is primarily for individuals with severe shoulder arthritis and a torn rotator cuff. It can also be beneficial for those with complex shoulder fractures.

The shoulder is a ball-and-socket joint that allows for a wide range of motion. The “ball” is the top of the upper arm bone (humerus), and the “socket” is a part of the shoulder blade (scapula) called the glenoid. The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, keeping the head of the humerus firmly within the shallow socket of the scapula.

In a healthy shoulder, the rotator cuff muscles not only move the arm but also help to keep the shoulder joint stable. When the rotator cuff is torn, particularly with a massive tear, the shoulder can become unstable and painful, and the patient may lose the ability to lift their arm. Over time, this can lead to a specific type of arthritis called “cuff tear arthropathy.”

Reverse total shoulder arthroplasty is a surgical procedure that involves replacing the damaged shoulder joint with artificial components, but with a key difference from a traditional total shoulder replacement. In a standard shoulder replacement, the prosthetic components mimic the natural anatomy of the shoulder. The humeral head is replaced with a metal ball, and the glenoid socket is replaced with a plastic component.

In a reverse total shoulder arthroplasty, the positions of the ball and socket are switched. A metal ball is attached to the glenoid, and a plastic socket is placed at the top of the humerus. This “reverses” the mechanics of the shoulder.

The design of the reverse total shoulder replacement allows the deltoid muscle to become the primary mover of the arm. In a shoulder with a healthy rotator cuff, the deltoid and rotator cuff work together to lift the arm. By reversing the ball and socket, the center of rotation of the shoulder is moved. This new positioning gives the deltoid muscle a better mechanical advantage, allowing it to lift the arm without the help of the rotator cuff. This is why the procedure is generally most effective for patients with massive, irreparable rotator cuff tears.

A reverse total shoulder arthroplasty is typically recommended for patients with specific conditions that have not responded to more conservative treatments like physical therapy, medication, and injections. Cuff tear arthropathy is the most common reason for a reverse total shoulder replacement. It is a condition where a patient has both severe shoulder arthritis and a massive, irreparable rotator cuff tear.

Additionally, in some cases of severe shoulder fractures, particularly in older patients with poor bone quality, a reverse total shoulder replacement may be a better option than trying to repair the fracture. An experienced shoulder surgeon can evaluate your condition and help determine if reverse shoulder replacement may be an option for you.

If considering reverse shoulder replacement, it is important to be well-informed about the procedure. While specific steps may vary, in the following subsections, we’ll give a general overview of what you can expect.

Before your surgery, you will have a thorough medical evaluation. This will include a physical examination, a review of your medical history, and imaging studies such as X-rays, an MRI, or a CT scan. Your surgeon will discuss the risks and benefits of the procedure with you and answer any questions you may have. You may be asked to stop taking certain medications before your surgery.

Reverse total shoulder arthroplasty is usually performed under general anesthesia. You will have a regional pain block to reduce postoperative pain. The surgery typically takes less than an hour. During the procedure, your surgeon will make an incision on the front of your shoulder. The damaged bone and cartilage will be removed, the sites will be prepared, and the prosthetic components will be implanted. The surgeon will test for proper fit and then close the incision.

After your surgery, you will be taken to the recovery room, where you will be monitored closely as you wake up from the anesthesia with your arm in a sling. Pain management is a priority after surgery. You may be given pain medication to help you stay comfortable. You may also be encouraged to start moving your fingers, wrist, and elbow soon after surgery to help prevent stiffness.

The recovery from a reverse total shoulder arthroplasty is a gradual process that requires patience and commitment to physical therapy. In the following subsections, we’ll review a general timeline of what you can expect.

For the first few weeks after surgery, your arm will likely be in a sling to protect the new joint. You will be given specific instructions on how to care for your incision and how to manage your pain. You may also begin physical therapy with some passive, gentle exercises to help maintain your range of motion.

Physical therapy is a key part of the recovery process. Your physical therapist can work with you to develop a personalized exercise program to help you regain your range of motion, strengthen your muscles, and improve your shoulder function. The program typically progresses in intensity over time.

It can take several months to a year to fully recover from a reverse total shoulder arthroplasty. It is important to be patient and to follow your surgeon’s and physical therapist’s instructions carefully. Many patients who have a reverse total shoulder arthroplasty experience a significant reduction in pain and an improvement in their ability to perform daily activities.

Precision shoulder replacement is an advanced approach designed to deliver more accurate implant positioning and improved outcomes compared to traditional methods. By utilizing detailed preoperative planning and patient-specific technology, each procedure can be tailored to each patient’s unique anatomy.

• Customized Implant Placement: Advanced imaging and planning help ensure optimal alignment, fit, and balance of the implant, which can enhance function and longevity.
• Improved Accuracy: 3D planning tools allow for exact implant sizing and placement.
• Educational Empowerment: We believe in empowering patients with knowledge about their procedure and recovery process every step of the way.
• Safety Commitment: Patient safety is our top priority. Using advanced surgical practices is aligned with our goal of reducing the risk of complications.
• Enhanced Recovery & Better Outcomes: We measure our success by your ability to embrace life fully.

Reverse total shoulder arthroplasty is a surgical procedure that may provide significant pain relief and improved function for many patients with complex shoulder problems. By reversing the anatomy of the shoulder, this innovative procedure allows patients to use the deltoid muscle to lift the arm, bypassing the damaged rotator cuff tendons. The recovery process is gradual and often requires a commitment to physical therapy. It is important to discuss your options with an experienced orthopedic surgeon to determine the best course of treatment for your individual needs.

In a traditional shoulder replacement, the prosthetic components mimic the natural anatomy, with a ball on the humerus and a socket on the glenoid. In a reverse total shoulder replacement, these positions are switched: a ball is placed on the glenoid and a socket on the humerus. This design allows the deltoid muscle to power arm movement when the rotator cuff is severely damaged.

Ability and timeline for returning to sports will depend on the sport and your individual recovery. In general, it may be advised to avoid high-impact sports and activities that involve heavy lifting. Your surgeon can give you specific recommendations based on your situation.

Light activities can often be resumed within a few weeks, but returning to more strenuous daily activities and work will depend on the nature of your job and your individual recovery progress. Some activities may need to be modified.