Reverse Shoulder Replacement

Arash Araghi, DO, is an orthopedic surgeon.

Question: What is reverse shoulder replacement?

Answer: Reverse shoulder replacement is a type of shoulder replacement surgery designed specifically for patients who are not candidates for the standard or anatomic total shoulder replacement. 

A number of conditions can make a total shoulder replacement more prone to failure in some individuals and, therefore, not a suitable surgical option. Two of the most common factors include arthritis and large rotator cuff tears. Total shoulder replacement in individuals with these conditions could result in early loosening of the joint and an increased likelihood of poor overhead mobility (lifting the arm above the head). While total shoulder replacement is generally the preferred treatment method, reverse shoulder replacement is a suitable and successful alternative.   

A semi-constrained procedure, reverse shoulder replacement relies on the power of a person’s deltoid muscle to elevate the arm. Classically performed in individuals over age 70, the procedure also has proven effective in those with inadequate bone stock resulting from arthritis that excludes them from undergoing total shoulder replacement, as well as individuals with complex shoulder fractures and/or massive rotator cuff tears.

Reverse shoulder replacement entails inserting a cup-shaped prosthesis into the upper portion of the arm bone with a metal, half-ball inserted into the socket to mimic the shape and function of the shoulder joint. The prosthesis is typically a combination of metals such as titanium and cobalt chrome separated by a layer of medical-grade plastic. 

Patients undergoing reverse shoulder replacement generally require only a one-night hospital stay followed by approximately eight to 10 weeks of physical therapy. They are often doing well and performing most if not all of their basic activities of daily living within two to three months of surgery. That being said, patients are encouraged to continue with home exercise activities for up to a year after surgery to maximize replacement benefits. 

As with most things, certain conditions can exclude a person from having reverse shoulder replacement. Active infections in the shoulder and poor or non-functioning deltoid muscles are two factors that would exclude someone from undergoing reverse shoulder replacement surgery. 

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