Reverse Total Shoulder Replacement

At OrthoBethesda, we proudly serve patients throughout Bethesda, MD, struggling with shoulder problems as well as a variety of other musculoskeletal issues. Conventional shoulder replacement surgery allows those with shoulder arthritis and other conditions to regain mobility and get relief from pain. However, this surgery may not be as beneficial for our patients with rotator cuff arthropathy.

This condition is a complex type of shoulder arthritis combined with a rotator cuff tear. In these situations, the team at OrthoBethesda may recommend reverse total shoulder replacement as a better option.

What Is Reverse Total Shoulder Replacement?

The shoulder joint is a ball and socket joint formed where the upper arm and shoulder socket meet. At the head of the upper arm, four tendons join to make the rotator cuff, which connects the bone to the deeper shoulder muscle providing stability and mobility.

Over time, the rotator cuff can become torn due to wear and tear or injury. A torn rotator cuff can also lead to shoulder arthritis. The combination of these issues is what's referred to as rotator cuff tear arthropathy. Total shoulder joint replacement is ineffective as a treatment for this condition and can even lead to pain and limited motion.

Reverse total shoulder replacement is an advanced surgical technique employed in cases of rotator cuff tear arthropathy. When the shoulder is healthy, the muscles of the rotator cuff power the arm's range of motion. A conventional total shoulder replacement uses these rotator cuff muscles to help the shoulder regain its mobility. However, when patients have a large rotator cuff tear, these muscles don't function properly.

Reverse total shoulder replacement reverses the placement of the implant components so it relies on the deltoid muscle instead of the rotator cuff.

Indications You May Need Reverse Total Shoulder Replacement

The symptoms of rotator cuff arthropathy include intense shoulder pain and weakness, usually experienced at night. You may have had a history of rotator cuff repairs. The most common symptom, however, is being unable to raise your arm above your shoulder or perform overhead activities.

Candidates for reverse total shoulder replacement include patients experiencing the following:

  • Rotator cuff arthropathy
  • Difficulty repairing the torn rotator cuff
  • Unsuccessful shoulder replacement
  • Extreme shoulder pain
  • Difficulty performing overhead activities
  • Continued pain despite conservative treatment measures such as rest, medication, injections or physical therapy

Your Reverse Shoulder Replacement Procedure

If your OrthoBethesda physician recommends reverse total shoulder replacement, they will go over the procedure with you to ensure you understand it fully ahead of time. Here are the general steps of the surgery:

  1. This surgery is performed under general anesthesia.
  2. Your surgeon will make an incision over your injured shoulder to expose the joint.
  3. The humerus, or upper arm, is separated from the socket of the shoulder blade.
  4. Any damaged tissue or arthritic parts of the head of the humerus and socket are removed, and the area is prepared for the insertion of the artificial components.
  5. The implant consists of a metal ball which is inserted into the shoulder socket as well as a plastic cup which is cemented into the upper arm bone.
  6. These components are fixed in place.
  7. Once the underlying tissue is replaced, the would is closed with sutures.

Recovery After Reverse Total Shoulder Replacement Surgery

After the procedure is complete, patients generally stay in the hospital for one to two day. Most individuals find they're able to get out of the bed the same day as the surgery. Once you go home, your doctor will recommend physical therapy to strengthen your shoulder and improve its flexibility. After rehabilitation, most patients are highly satisfied and find that the procedure provides outstanding pain relief and increased mobility.

Some of your doctor's post-operative instructions will include to:

  • Take pain medications as instructed
  • Perform instructed exercises at home to increase your range of motion
  • Avoid all overhead activities for six weeks at least
  • Not use your shoulder muscles to push yourself up out of bed or a chair
  • Refrain from lifting heavy objects

There are also a few potential risks and complications associated with reverse total shoulder replacement, including:

  • Dislocation of the implanted joint
  • Joint instability
  • Infection
  • Fractures to the humerus or scapula
  • Nerve or blood vessel damage
  • Blood clots
  • Irritation to the would
  • A discrepancy in arm lengths
  • Implant components wearing out

Contact OrthoBethesda for More Information About Reverse Total Shoulder Replacement

For patients living in Bethesda, MD, OrthoBethesda is here to treat many musculoskeletal issues, including various shoulder conditions. If you suspect that you may have rotator cuff arthropathy, then contact us today to find out about reverse total shoulder replacement and other treatment options available. Our team of highly trained orthopedic surgeons will ensure you receive the best care possible. Give us a call at (301) 530-1010 to make your appointment.

  • American Medical Association
  • American Society for Surgery of the Hand - ASSH
  • American Academy of Orthopaedic Surgeons - AAOS
  • American Board of Orthopaedic Surgery
  • North American Spine Society - NASS
  • American Association of Hip & Knee Surgeons - AAHKS