Glenohumeral (shoulder) arthritis occurs when the protective cartilage on the surface of the glenoid (socket of the shoulder joint) and the humeral head (ball of the shoulder joint of the upper arm) wears out.
The most common indication for reverse total shoulder arthroplasty is painful rotator cuff arthropathy, which is shoulder arthritis associated with a large rotator cuff tear. Reverse total shoulder arthroplasty may also be indicated for pain associated with large irreparable rotator cuff tears, severe fractures of the proximal humerus in older patients, revision shoulder replacement, significant glenoid deformity, or arthritis with shoulder instability.
What Is Reverse Total Shoulder Arthroplasty?
In a reverse total shoulder replacement, the normal ball-and-socket relationship is reversed. The ball is placed over the glenoid (socket), and the socket is placed on the humerus (arm bone).
Significant or massive rotator cuff tears that are left untreated can cause the humeral head to migrate upward toward the acromion (roof of the shoulder joint). This abnormal position can cause the cartilage covering the bony surfaces to deteriorate, leading to arthritis, pain, and physical limitations.
Reverse total shoulder replacement has been found to produce better outcomes than traditional total shoulder arthroplasty in patients who do not have a properly functioning rotator cuff.
Who Is a Candidate?
The most common indication for reverse total shoulder arthroplasty is painful rotator cuff arthropathy.
Reverse total shoulder arthroplasty may also be indicated for patients with:
- Pain associated with large irreparable rotator cuff tears
- Severe fractures of the proximal humerus in older patients
- Revision shoulder replacement
- Significant glenoid deformity
- Arthritis with shoulder instability
Surgery may not be appropriate in the presence of:
- Infection
- Poor general health that is not sufficient to proceed with surgery
- No functioning deltoid
- An inability or unwillingness to complete the postoperative program, including wearing a sling for six weeks and participating in physical therapy two to three times per week for four months
How the Procedure Is Performed
Reverse total shoulder arthroplasty may be performed as outpatient surgery or with a 23-hour overnight stay. General anesthesia with an interscalene nerve block is used.
Dr. Chudik makes a limited incision over the front of the shoulder and works through intervals in the shoulder and chest muscles to resurface the humerus (ball) and the glenoid (socket).
The worn surfaces are replaced with metal and special plastic components that are fit to the shoulder. In a reverse total shoulder replacement, the ball is placed over the glenoid and the socket is placed on the humerus.
Recovery and Rehabilitation
Following surgery:
- A sling is worn at all times except for bathing, dressing, and exercises for six weeks, including while sleeping.
- The replaced shoulder should not be actively moved using its own shoulder muscles for four to six weeks to allow the soft tissues to heal.
- Patients may feel more comfortable sleeping upright on a couch or recliner after surgery.
- The wound should remain clean and dry for 10 to 14 days following open shoulder surgery.
- Light showering may begin after 14 days, but the wound should not be submerged under water for three weeks.
- Driving may resume after six to eight weeks.
- Patients may return to school or sedentary work in less than one to two weeks as long as the arm remains in the sling and is not used.
- Physical therapy should begin two to three days after surgery and continue for four months.
The success of reverse total shoulder arthroplasty is highly dependent on postoperative rehabilitation, making it important to follow and maintain the prescribed therapy schedule.
Patients may return to activities when rehabilitation is complete and functional use has been restored. Usually four to six months is necessary before returning to activities. Full shoulder motion and strength are necessary before returning to activities.
Dr. Chudik also has special protocols for returning to golf.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Bleeding
- Rare injury to nerves of the shoulder and arm, which may cause numbness, weakness, or paralysis
- Persistent stiffness or loss of shoulder motion
- Loosening of the prosthesis, particularly the glenoid implant
- Moving or breaking of surgical hardware
- Need for revision surgery
- Instability or dislocation
Reverse total shoulder replacement has been found to produce better outcomes than traditional total shoulder arthroplasty in patients who do not have a properly functioning rotator cuff.
Why Dr. Chudik for RTSA
Dr. Chudik treats the full range of indications for reverse total shoulder arthroplasty, including primary cases, complex fracture patterns, and revision arthroplasty. His experience across the spectrum of shoulder pathology, including the rotator cuff disease that often precedes RTSA candidacy, informs implant selection and surgical planning. He has performed shoulder arthroplasty for more than two decades.