Reverse Total Shoulder Replacement

This surgery is typically indicated for patients with rotator cuff tear arthropathy, a condition where the shoulder joint suffers severe arthritis after the rotator cuff is severely damaged and untreated.

Other indications include complex fractures of the shoulder, failed previous shoulder surgeries, or severe shoulder instability. It is especially beneficial for patients who do not respond to conservative treatments like physical therapy or medications.

The first step is to schedule a consultation with Dr. Kaplan. He will perform a comprehensive evaluation of the shoulder joint to assess the severity of damage and determine the suitability of the procedure. The process includes the following key components:

Dr. Kaplan will review your medical history, including symptoms, duration of pain, impact on daily activities, previous injuries, and any treatments tried (e.g., physical therapy, medications). He will perform a physical exam to assess shoulder function. This involves checking range of motion and evaluating the strength of the shoulder muscles and the rotator cuff. He will feel for tenderness, swelling and deformities around the joint, and test joint stability.

Dr. Kaplan will order imaging studies to visualize the condition of the joint including X-rays for detailed images of the bones in the shoulder, to reveal the extent of arthritis, bone spurs, or joint deformities. He may also order an MRI or CT scan for more detailed imaging to evaluate bone quality, the condition of the rotator cuff, and the soft tissue structures around the joint.

During the surgery, an incision is made over the shoulder to access the joint. The damaged joint surfaces are removed, and the new prosthetic components (ball and socket) are placed in a reverse configuration. This reversal allows the deltoid muscle to lift the arm instead of the rotator cuff. The procedure usually takes about 2 hours and is performed either with general anesthesia or a nerve block with sedation.  Patients typically go home the same day as the operation (same-day surgery).

Post-surgery, patients typically wear a sling for several weeks to protect the shoulder. Physical therapy is a crucial part of recovery, focusing on restoring strength and range of motion. Most patients start gentle exercises within the first few weeks and progress to more intensive therapy over the next several months. Full recovery usually takes 4 to 6 months, although this can vary depending on individual health and the complexity of the procedure.

Reverse total shoulder replacement has a high success rate at relieving pain and improving shoulder function in elderly, low demand patients. 85-90% of patients experience significant pain relief and improvements in their ability to perform daily activities. However, there may be some limitations in shoulder movement, such as reaching overhead, due to the altered joint mechanics. The prosthetic components typically at least10 to 15 years before needing to be replaced.