Reverse Shoulder Replacement

The reverse total shoulder replacement arthoplasty enables shoulder surgeons to treat patients with conditions that previously had no solution. This procedure was developed in France and has been recently approved by the FDA for use in the United States.

The most common situation is a massive rotator cuff tear that cannot be repaired with surgery. Patients with this condition can be severely disabled by pain and loss of motion of the shoulder. Some patients, for instance, develop pseudoparalysis or the inability to raise the arm above shoulder level due to dysfunction of the rotator cuff. The proximal humerus migrates superiorly and medially such that the deltoid becomes lax and cannot generate normal force which requires a reasonable amount of resting tension. This dysfunction can also lead to painful arthritis as the mechanics of the shoulder change and result in cartilage wear. While rotator cuff repair is an option, many rotator cuff tears are not repairable. Reverse shoulder replacement can be a solution in this setting.

In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm by medializing the center of rotation and reestablishing tension in the deltoid.

- Patrick J. Denard, MD