The explosion in the number of total shoulder replacement surgeries had previously done little to help those with severe rotator cuff injuries, but now the reverse total shoulder replacement has given those patients an option to escape chronic shoulder pain.
In a traditional total shoulder replacement surgery, the ball-and-socket joint of the shoulder are replaced with an artificial ball grafted onto the top of the arm, and the socket component in the shoulder. However, if you don’t have a good rotator cuff, which are the muscles that stabilize the shoulder, and you have arthritis, then a regular shoulder replacement would fail.
Reverse total shoulder replacement, approved by the FDA in 2003, offers a solution. A hemisphere is installed on the shoulder blade, while a socket joint is attached to the top of the arm bone.
Following a reverse total shoulder replacement, the joint is powered by the deltoid muscle instead of the rotator cuff. There are a number of special cases in which a reverse total shoulder replacement can provide relief:
- Irreparable torn rotator cuff
- Cuff tear disease, referred to as arthropathy
- An unsuccessful previous replacement
- Severe shoulder pain and difficulty lifting your arm away from your side or over your head
- Complex fracture of the shoulder joint
- Chronic shoulder dislocation
- Tumor of the shoulder joint
The reverse total shoulder replacement procedure has been shown to deliver improved results for patients with severe rotator cuff damage, but initially carried a higher rate of complications than the traditional replacement.
The most common complication, according to a 2010 study at the University of Zurich, was scapular notching — an erosion of the scapular neck due to impingement of the rim of the cup of the joint. That could also be prevented, according to the study, by use of larger implant components and shifting the positioning of the implant.
Haematoma, a swelling of a blood clot, the study noted, was a common issue, but that it was one that could be better controlled.
Following years of advancement in techniques and technology, the risks of the procedure have been reduced, as the long-term reliability of new joints have improved for those suffering from some of the most extensive cases of joint damage.