Total Reverse Shoulder Arthroplasty

The shoulder is a ball and socket joint. A total shoulder replacement is designed to imitate normal anatomy. The shoulder socket (glenoid socket) is replaced with man-made parts and the head or ball of the upper arm bone (humerus) is replaced. The rotator cuff muscles operate the arm. In the reverse shoulder replacement, the ball of the humerus is attached to the socket and the socket is attached to the upper end of the humerus. The rotator cuff no longer functions and cannot be used. Instead, the reverse procedure relies on the deltoid muscle to control the arm.

Reverse total shoulder arthroplasty (RTSA) is a successful surgical procedure to relieve shoulder pain and restore shoulder function for patients with severe rotator cuff tears.  It is safe and effective and allows patients to resume an active lifestyle. Replacement parts last between 15-20 years.

Reverse shoulder replacement indications:

  • Severe shoulder arthritis and rotator cuff deficiency

  • Irreparable massive rotator cuff tears without arthritis

  • Revision surgery after failure of previous shoulder replacement

  • Chronic shoulder dislocation

  • A complex fracture of the shoulder joint common in the elderly

  • Patients whose symptoms and function fail to improve after a trial of conservative measures such as rest, medications, injections and physical therapy

What are the symptoms?

Symptoms are pain, weakness, stiffness and instability; and functional disability that interferes with normal daily activities. These patients have a loss of normal mechanics, and pseudoparalysis (the inability to raise the arm more than 45º).

Diagnosis

Dr. Johnston will ask about your symptoms including pain, stiffness, weakness and grinding with movement, examine your shoulder and test function, range of motion and order x-rays and other imaging studies to evaluate your bones and rotator cuff tissue. When the rotator cuff is irreparable, a reverse shoulder procedure is indicated.

For patients with these symptoms and a deficient rotator cuff, a reverse shoulder replacement can provide pain relief and improved function because it does not rely on the rotator cuff to move the arm. Instead, the reverse procedure relies on the deltoid muscle to power the arm.

The RTSA approach is perfect when the damaged shoulder needs new surfaces, but there is not enough healthy tissue to stabilize and move the shoulder.

The procedure

Reverse shoulder replacement can be an inpatient or outpatient surgery performed under regional anesthesia. It replaces the damaged parts of the joint with man-made parts and uses the deltoid muscles to restore shoulder function. Most patients stay one night in the hospital.

When you awaken your arm will be in a sling. Physical therapy starts almost immediately with gentle range of motion exercises. After a few weeks you will begin formal rehabilitation to strengthen the shoulder and improve range of motion. To achieve the full benefits from these procedures it is important to commit to the rehabilitation program.

RTSA is complex procedure that requires specialized technical skills performed by a team of specialists experienced in this procedure. Dr. Peter Johnston is a board-certified and fellowship-trained shoulder and elbow specialist skilled and experienced in complex procedures of the should with both open and arthroscopic procedures.  He is committed to compassionate, patient-centered care. Dr. Johnston offers cutting edge technology, evidence-based procedures for all of his patients. Contact his office in Leonardtown or White Plains Maryland to schedule a consultation to receive the correct diagnosis and all your treatment options.