Reverse Shoulder Replacement Surgery: Why Effective Shoulder Repair May Require a Backwards Approach by Dr. Alejandro Badia

When it comes to shoulder repair, some surgeons are defying nature and doing it all backwards – and studies are showing that can be a good thing. I'm referring to reverse shoulder replacement, also called reverse shoulder arthroplasty, in which artificial parts are used to change the natural anatomy of the shoulder’s ball-and-socket joint – the glenohumeral joint – by turning the ball at the top of the humerus (arm bone) into a socket and making the socket on the shoulder blade a ball.

The Reserve Shoulder Replacement Procedure

This procedure is complex and highly technical, requiring skill and experience. But switching the ball and socket can create a more stable joint with a fixed fulcrum in patients with severe shoulder damage, particularly damage involving the rotator cuff. That’s because the rotator cuff, a group of muscles and tendons, is what normally powers the shoulder joint, allowing it to move and function properly. 

The rotator cuff keeps the ball of the arm bone centered on the shoulder-blade socket during joint rotation, including raising the arm. If the rotator cuff is too extensively torn, its tendons pulled from the bone, then a standard shoulder replacement, which maintains the shoulder’s natural ball-and-socket anatomy but requires an intact rotator cuff, will not prove effective in restoring regular shoulder function.

Instead of relying on a damaged rotator cuff, a reverse shoulder replacement makes joint movement dependent on the deltoid muscle, a large, triangular-shaped muscle located on top of the shoulder and the uppermost part of the arm.

Who Should Consider Reverse Shoulder Replacement?

Most commonly, a reverse shoulder replacement is recommended for patients with significant pain due to extensive shoulder-joint osteoarthritis, with bone loss and missing or badly torn rotator cuff tendons, or for those whose quality of life is seriously impacted because a damaged rotator cuff prevents them from lifting their arm high enough for good functioning.

A complex upper arm bone fracture that involves damage to the shoulder-joint ball, chronic shoulder-joint dislocation and a failed previous shoulder replacement also may necessitate a reverse replacement procedure.

Shoulder replacement procedures in general have been increasing. Data from the Agency for Healthcare Research and Quality indicate more than 50,000 patients undergo shoulder replacement annually in the United States. Of these surgeries, as many as half are now reverse shoulder replacements, even though the procedure was only approved for use by the federal Food and Drug Administration about 15 years ago.

Reverse Shoulder Replacement Outcomes

Because of the relative “newness” of reverse shoulder replacement, research to determine long-term outcomes of the procedure as it is performed in the U.S. remains scant. However, studies in Europe, where the surgery has been done since the 1980s, underscore the procedure’s success in providing pain relief to as many as 90 percent of patients, restoring range of motion to the shoulder and maintaining joint stability, with the prostheses – artificial parts used for reverse shoulder replacement – lasting up to 15 years.

In the U.S., a one-year follow-up of more than 200 patients who had undergone reverse shoulder replacement in 2017 at an average age of 70 showed “improvement in overall shoulder pain, function and satisfaction,” according to the Cleveland Clinic’s Orthopaedic and Rheumatologic Institute.

Similar findings were reported in a study of “younger” and “more active” patients – those under age 60 – who had undergone reverse shoulder replacement due to massive, irreparable rotator cuffs and were followed up eight years or more after surgery. In that research, published in 2017 in The Journal of Bone & Joint Surgery, authors contend that the majority experienced “substantial and lasting improvement” in shoulder movement and strength and overall pain relief.

This same study found the rate of complications to be somewhat high – 39 percent. Complications can include loosening of prosthetic implants, instability of the reversed shoulder joint, persistent pain, nerve damage, bone fracture around the implant or overstressed deltoid muscle.

Ongoing advancements in prosthesis design, such as implants with shorter stems for the arm bone, and continuing improvements in surgical approaches are significantly reducing frequency of complications.

The information on 30Seconds.com is for informational and entertainment purposes only, and should not be considered medical advice. The information provided through this site should not be used to diagnose or treat a health problem or disease, and is not a substitute for professional care. Always consult your personal healthcare provider.

Take 30 seconds and join the 30Seconds community. Inspire and be inspired.