Reverse shoulder replacement is a surgical procedure used to replace a damaged shoulder joint. It is particularly useful for people who have a damaged rotator cuff along with shoulder arthritis.
What is reverse shoulder replacement?
The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place. If these tendons tear it causes pain and weakness in the shoulder joint. There are a number of surgical procedures for repairing torn rotator cuff tendons, but when they are severely damaged and arthritis is present, reverse shoulder replacement (also called reverse shoulder arthroplasty) may be the best option.
They body’s shoulder is a ball-and-socket joint whereby the top of the arm is shaped like a ball that fits into a socket in the shoulder blade. Reverse shoulder replacement surgery reverses this ball-and-socket mechanism. A surgeon attaches an artificial ball to the shoulder blade and an artificial socket to the top of the arm. This results in added stability.
What are its advantages?
Other surgical procedures and prosthetic implants require the rotator cuff muscles and tendons to work. The main advantage of reverse shoulder replacement is the gaining of full shoulder functionality when the rotator cuff’s integrity has been compromised.
The procedure takes approximately 2 hours. Stitches are removed around 2 or 3 weeks later, and the arm is immobilised in a sling for approximately a month.
It is important to follow a good rehabilitation programme that strengthens the deltoid and peri-scapular muscles. This ensures that the shoulder achieves the greatest possible mobility without pain.
Results are usually very good. Close to 90% of patients experience significant pain relief, and their ability to move their arm increases substantially.
When not to do this procedure
While this is a relatively new surgical procedure, the literature thus far shows complications only arise in around 10% of cases. Problems include infection, prothesis dislocation, loosening of components, and fractures around the implant.
Reverse shoulder replacement is not recommended in patients under the age of 65, as the benefits may not last beyond 15 years and revision surgery success rates are lower. In addition, it is also not recommended in patients lacking deltoid muscle or suffering from axillary nerve palsy.
Hospital Ochoa has a specialised Upper Limb Unit headed by Dr. Carlos Peña, which has obtained great results performing this surgical procedure.