Shoulder and Elbow Services

Reverse Total Shoulder Arthroplasty (Reverse Shoulder Replacement Surgery)

Overview

This procedure is aimed at providing relief to the hundreds of patients suffering with an irreparable rotator cuff tear and advanced degenerative joint disease of the shoulder. The procedure is appropriate when a routine total joint replacement will relieve pain but not allow normal motion. It was approved by the U.S. Food and Drug Administration in 2004, and has been routinely performed in Europe previously. The technique is performed at URMC by Richard J. Miller, MD, Chief of Hand and Wrist Services and Ilya Voloshin, MD, Chief, Shoulder and Elbow Services.

Who Should Consider Reverse Total Shoulder Arthroplasty

Reverse total shoulder surgery is the answer for patients who have exhausted all other means of repair of their degenerated shoulder. Often, patients with large tears in their rotator cuff, who also have severe arthritis, are the best candidates. These are people who have significant pain and little to no movement in their shoulder. It is also commonly used for patients who don’t have a rotator cuff (pseudo-paralytic shoulder).

Effectiveness

After recovery from the procedure, patients who could barely move their arms are typically able to raise their hands above their heads. 

How the Procedure Works

A multi-part prothesis (implant) is implanted to provide restored motion, pain relief, and increased stability. The procedure actually reverses the anatomic structure of the shoulder and changes the mechanics, or workings, of the shoulder.

In the healthy shoulder, the humerus ends in a ball shape, which fits into a socket formed by the scapula, creating the glenohumeral joint. During the surgery, the implant places the ball portion of the device to the scapula, while the socket is attached to the top of the humerus. This placement creates a new center of rotation. So, the strength needed to move the arm is shifted away from the damaged rotator cuff muscles and to the deltoid muscle. The general shape of the shoulder remains the same even though the ball and socket are reversed.

View the Reverse Total Shoulder Replacement Tutorial

Risks and Contraindications

This procedure is not recommended for people who have infections, deficiencies in the scapula, or for patients without functioning deltoid muscles. It is also not recommended for patients younger than 70 years of age.

After Care

After the surgery, patients start physical therapy in a month. A full recovery usually takes about three months.