Reverse Total Shoulder Replacement

For patients suffering from more advanced forms of shoulder arthritis, or chronic pain from the degenerative damage of the shoulder joint, shoulder replacement surgery (also known as shoulder arthroplasty) can be a tremendously effective option to improve pain and motion in the arm. Traditional shoulder replacement surgery involves replacing the damaged ball and socket in the shoulder joint while maintaining the rotator cuff.  

Another common degenerative condition in the shoulder is called rotator cuff tear arthropathy. This is a result of tearing where the rotator cuff can no longer center the ball in the socket of the shoulder joint and the ball begins to erode the shoulder socket with use of the arm. This condition is like having a car with rusty wheels and a bad engine and can leave the patient with pain and weakness.

What Is a Reverse Shoulder Replacement?

In cases where the rotator cuff is badly damaged and the joint has worn out, a newer type of replacement using a "reverse" approach can be very effective in allowing the patient to lift overhead and more easily reach for things without pain, which may have previously been impossible. 

Reverse total shoulder arthroplasty, or reverse total shoulder replacement surgery, is an alternative to traditional shoulder replacement surgery. The unique implant design changes the mechanics of the shoulder, as the ball-and-socket device that is used for traditional repair is reversed. This form of shoulder replacement can help to relieve intense pain when performing routine tasks, such as cleaning, dressing, and combing hair.

Before Undergoing a Reverse Total Shoulder Replacement

History of Injury: Although some people may need a reverse or total shoulder replacement after an injury, more often, the procedure is performed on people who are dealing with the effects of osteoarthritis in the setting of a large rotator cuff tear.

Diagnosis: Your surgeon will ask you questions about your general health as well as your shoulder joint pain and how it is impacting your ability to function. He or she will also perform a physical exam to assess the strength, range of motion, and stability of your shoulder joint. To better understand the location and the extent of the damage, you will have X-rays taken of your shoulder. Depending on your situation, your orthopedic surgeon may also order blood tests or an MRI.

Treatment: Treatment depends on the extent and location of your shoulder damage. You may need a joint replacement, such as a traditional shoulder replacement or a reverse shoulder replacement, where the top of your humerus (ball) and the glenoid cavity of your scapula (socket) are replaced. It is possible you may only need a reparative procedure for the rotator cuff or its tendons.

Initial: Before recommending a shoulder replacement, either traditional or reverse, your surgeon may suggest other treatments, such as anti-inflammatory medications, prescribed pain medications, steroid injections, or physical therapy.

Long-Term: If nonsurgical treatments are not helpful or no longer relieve pain, shoulder replacement or a reverse shoulder replacement could be a good option for you.

Indications for Surgery: If you have osteoarthritis and/or rotator cuff arthropathy and your shoulder pain is interfering with your daily life—even while you are resting—you may be a good candidate for a reverse shoulder replacement. 

Your Surgery, Recovery, and Living With Your New Shoulder

Surgery: The procedure takes place in a hospital. After you are given anesthesia, your surgeon will make an incision between two muscles on the front of your shoulder—the deltoid and the pectoralis major. Next, he or she will replace both sides of your joint, the humeral head (ball) and the glenoid (socket). This differs from a traditional shoulder replacement in that a reverse prosthesis is used. Here, the new ball, or humeral component, is attached the socket side of the joint, and the new socket, or glenoid component, is attached to the humerus (upper arm bone).

Post-Surgery: After your shoulder replacement surgery, you will be moved to another room, where you will remain for several hours while you recover from your anesthesia. When you wake up, you will be wearing a sling. You should carefully follow your orthopedic surgeon’s instructions regarding when you can remove the sling and move your elbow, wrist, fingers, and shoulder.

Rehabilitation: Your surgeon will provide you with specific instructions about what you can and cannot do while your shoulder is healing. You will need to keep the sling on for several weeks after surgery and do exercises and stretching activities consistently, at home or working with a physical therapist, to help your shoulder heal properly. 

Risks and Complications: As with any surgery, there is a risk of infection or blood clots. You should avoid lifting heavy weights overhead with the weight behind your head, as doing so risks dislocation or re-injuring your shoulder. 

Both reverse and traditional total shoulder replacement are performed to provide pain relief and restore and maintain the function of the shoulder and arm. Total shoulder replacement is more suitable for patients with certain forms of arthritis, including osteoarthritis, or wear-and-tear degeneration; rheumatoid arthritis, or autoimmune-related chronic joint inflammation; and post-traumatic arthritis, or severe damage associated with fractures or another traumatic injury.

For patients who have rotator cuff arthropathy or even a large rotator cuff tear, reverse shoulder replacement can reduce pain and restore range of motion in the joint. Only an orthopedic specialist will be able to determine which form of shoulder joint replacement is most appropriate for your unique condition and lifestyle. 

The Shoulder Expert at Litchfield Hills Orthopedic Associates

Our fellowship-trained shoulder surgeon, Dr. Leigh Brezenoff, is experienced and skilled in providing expert care. Though many shoulder conditions can be treated conservatively, there are injuries or conditions that may require surgery. Dr. Brezenoff offers a number of specialized nonsurgical joint treatments including corticosteroid joint injections, and viscosupplementation. Before recommending surgery, he also ensures that other measures have been taken to relieve your pain, including anti-inflammatory medications, injections, or physical therapy.

If surgical intervention is necessary for you, Dr. Brezenoff has the advanced training and expertise to perform your reverse total shoulder replacement surgery. He also offers several other advanced procedures, including:

  • Arthroscopic shoulder stabilization
  • Cartilage preservation of the shoulder
  • Rotator cuff repair
  • Shoulder arthroscopy
  • Total shoulder replacement

At Litchfield Hills Orthopedic Associates, our orthopedic specialists and staff understand the first step towards reducing your shoulder pain and restoring your health is a proper diagnosis to determine the specific cause of your pain. Schedule a consultation with our specialty-trained shoulder surgeon today, and discuss your condition and treatment options. You can request an appointment online or call (860) 482-8539 and be seen in Torrington or Bristol.