Orthopaedics Unlimited

Reverse Total Shoulder Replacement

Reverse total shoulder replacement is a procedure that was developed in Europe during the 1980s for patients suffering from severe musculoskeletal shoulder issues. Reverse total shoulder replacement proved to be an effective solution for completely torn rotator cuffs coupled with severe arthritis, as well as previous joint replacements that have since failed. A recently developed minimally invasive procedure, reverse total shoulder replacement was approved in the early 2000s, and has been performed in the US since 2004. Today, reverse total shoulder replacement is considered one of the safest procedures performed.

In severely arthritic patients, as well as those with irreparable rotator cuff damage or failed joint replacements, traditional joint arthroplasty will leave the patient in pain, and will not provide the stability required for the patient's daily routine. Without pursuing a reverse total shoulder replacement, the patient may not be able to lift their arm past a 90-degree angle, severely limiting the function of the upper body.

Anatomy of the Shoulder

The shoulder is made up of two joints: the glenohumeral joint and the acromioclavicular (AC) joint. The former refers to the joint comprised of the upper arm and shoulder, while the latter refers to the joint consisting of the collarbone and shoulder socket.

Glenohumeral Joint

The glenohumeral joint is the main ball-and-socket joint of the shoulder, and is made up of two main bones: the humerus (upper arm bone), and the scapula (shoulder blade). The humerus connects to the glenoid, the end of the scapula, and is surrounded by a ring of cartilage called the labrum, which stabilizes the joint. The ball-and-socket design of the glenohumeral joint provides extensive range of motion to the shoulder and upper arm. Articular cartilage lines the joint cavity and allows the humerus to move freely within the socket.

Acromioclavicular Joint

The AC joint connects the scapula to the collarbone. The top wing of the scapula, known as the acromion, connects to the collarbone (clavicle). While this joint can be affected by arthritis and other shoulder disorders, the glenohumeral joint is prone to more damage and instability.

Shoulder Arthritis

In patients experiencing shoulder arthritis, pain will present itself in either the back of the shoulder or the front. Pain in the front of the shoulder indicates damage to the acromioclavicular joint, while pain in the back of the shoulder indicates infection of the glenohumeral joint. Pain will intensify with abrupt climate changes; motion and activity will also contribute to exacerbation of the symptoms associated with shoulder arthritis.

Rotator Cuff Tear Arthroplasty

Rotator cuff tear arthroplasty is a degenerative condition in which both onset of arthritis and rotator cuff tears have affected a shoulder joint. Patients suffering from cases of rotator cuff tear arthroplasty may be candidates for reverse total shoulder replacement if noninvasive methods of treatment (physical therapy, shoulder exercises) have failed to alleviate symptoms.

Total Shoulder Replacement vs Reverse Shoulder Replacement

Reverse total shoulder replacement is performed in the same manner as a traditional shoulder replacement; however, the ball and socket components are flipped and placed on the opposite bones. In a traditional total shoulder replacement, the top of the humerus is removed and replaced with a metal component. The damaged portion of the socket is shaved away, and the surgeon inserts a new plastic socket secured to the scapula using cement. In a reverse total shoulder replacement, the surgeon places a ball component within the scapula and attaches a socket to the top of the humerus.

Orthopaedic Excellence in New Jersey

Surgery should only be pursued if noninvasive, conservative methods of treatment have failed to properly alleviate pain and other symptoms associated with the musculoskeletal disorder. These conservative treatments include physical therapy, corticosteroid injections into the joint, as well as pain medication such as NSAIDs (non-steroidal anti-inflammatory drugs).

Dr. Rieber, with offices conveniently located in both Springfield and Newark, New Jersey, can properly assess your shoulder disorder to determine the best solution to alleviate the pain and instability that limit your day-to-day activities. You don't have to live with shoulder pain; find out how to schedule an appointment at Dr. Riber's two New Jersey offices.