Conventional surgical methods such as total shoulder joint replacement have shown limited efficacy in treating rotator cuff arthropathy, as it can lead to loosening of the implants due to the torn rotator cuff. Reverse total shoulder replacement was developed to address this issue. In this surgery, the artificial components' placement is reversed, meaning the humeral ball is placed in the glenoid cavity of the shoulder blade (scapula), and the plastic socket is placed on top of the arm bone, making efficient use of the deltoid muscle to compensate for the torn rotator cuff.
Patients with rotator cuff arthropathy may experience pain, weakness, and an inability to raise their arm above the shoulder for overhead activities. Reverse total shoulder replacement may be recommended for patients with a completely torn rotator cuff that is difficult to repair, presence of cuff tear arthropathy, previous unsuccessful shoulder replacement, severe shoulder pain, and difficulty in performing overhead activities, or continued pain despite other treatments such as rest, medications, cortisone injections, and physical therapy.
The surgery is performed under general anesthesia, and the procedure involves removing the arthritic parts of the humeral head and socket and replacing them with artificial components. Patients can get out of bed on the same day of surgery, and they usually stay in the hospital for 1-2 days. Post-operative care involves gentle range of motion exercises to increase shoulder mobility, physical therapy, avoiding overhead activities for at least 6 weeks, and avoiding lifting heavy objects.
Possible risks and complications associated with reverse total shoulder replacement surgery include infection, dislocation or instability of the implanted joint, fracture of the humerus or scapula, damage to nerves or blood vessels, blood clots, wound irritation, arm length discrepancies, and wearing out of the components.