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Reverse Total Shoulder Replacement
Each year, more than 700,000 people in the United States undergo hip or knee replacement surgery, while only approximately 60,000 will undergo a similar procedure for the shoulder. This much less common procedure can successfully relieve pain in the shoulder for conditions such as degenerative joint disease (osteoarthritis) and arthritis. However, the best results with traditional total shoulder replacement have been in patients with little or no damage to the rotator cuff (group of tendons and muscles that attach the upper arm to the shoulder blade).
For other patients who suffer from severe arthritis combined with a torn rotator cuff, not only can the pain be devastating, but also function can be lost, and the standard replacement surgery may not be adequate.
Andrew Green, MD and E. Scott Paxton, MD, orthopedic surgeons with Rhode Island Hospital and The Miriam Hospital, are two of a few surgeons performing a procedure that began in Europe and is now taking hold in the United States: reverse total shoulder replacement.
Reverse total shoulder replacement offers pain relief combined with functional restoration for those patients, substantially improving their quality of life.
How It Works
The shoulder is made up of a ball and socket-the top of the upper arm bone (the humerus) is the ball, and it rests in a socket (the glenoid) in the shoulder blade (the scapula). In standard replacement surgery, a plastic socket and metal ball are used to replace the damaged areas in their correct locations.
Reverse total should replacement, however, completely changes the structure so that the socket and the ball are actually switched. A metal ball is placed onto the scapula and the socket is moved to the top of the humerus. This ultimately shifts the center of rotation, and the arm no longer needs to rely on the damaged rotator cuff tendons and muscles. Instead, movement will then rely on the stronger shoulder muscle known as the deltoid. While an X-ray will clearly show the change, the general shape of the shoulder remains the same.
Patients who undergo the surgery will begin physical therapy to allow them time to adjust to the new shoulder, while allowing the shoulder to heal and pain to decrease. Typically, six weeks following the procedure, the patient will be able to raise the arm and then continue with progressive motion and strengthening exercises.