Comparing Reverse to Traditional Shoulder Replacement
Reverse total shoulder replacement has become the most common type of shoulder replacement for an arthritic shoulder. With a traditional shoulder replacement (called an anatomic shoulder replacement), the arthritic humeral head is replaced with a metal humeral head of a similar size, and the socket (glenoid) covered with a plastic insert. But with a reverse shoulder replacement, the humeral head is replaced with a socket, and the socket is replaced with a metal ball, or glenosphere.
By reversing, or inverting, the joint, the socket engages and rotates around the ball. Because of the stability of this design, even patients who do not have a good rotator cuff can establish good range of motion after the surgery and this helps to improve function. A good rotator cuff is necessary for good movement and strength after an anatomic shoulder replacement because it squeezes the humeral head into the socket, stabilizing the joint, which is critical for shoulder function.
Want to learn more? In this video, Dr. Romeo discusses the principles and science behind reverse shoulder arthroplasty.
Benefits of Reverse Shoulder Replacement
Reverse shoulder replacements first became available in the United States in 2003. In the beginning, it was used only for patients who had a bad rotator cuffs and arthritis. Now, this design has been shown to work well with many conditions, including shoulder fractures, revision of prior shoulder replacement and rotator cuff surgery, and for patients over the age of 70 with arthritis, even if the rotator cuff is not torn. The many indications have led to the fact that more than 50% of all shoulder replacements are now done with the reverse prosthesis.
Our recent studies have shown that more than 90% of these procedures last more than 10 years without the need for additional surgery, and up to 75% still doing very well at 15 years. Patients are returning to many of life’s activities without pain, including washing their hair or reaching into the cupboard above the counter, as well as recreational activities such as golf, tennis, swimming, and fitness training.
Many patients have the misconception that having a shoulder replacement will have a negative effect on the use of their arm, when in fact it is common for them to have more comfort, more movement, and more function after reverse shoulder replacement. Want to learn more? In this video, Dr. Romeo’s patient, Janet S, discusses her thoughts about having a reverse shoulder replacement:
In this video, Dr Romeo discusses what activities and sports patients can expect to participate in after a reverse shoulder replacement:
Reverse Shoulder Replacement FAQ
Who is a candidate for reverse shoulder replacement?
A reverse shoulder replacement is recommended when there is:
- A damaged rotator cuff with shoulder joint arthritis
- Shoulder joint arthritis for most patients over the age of 70
- Shoulder joint arthritis with a history of prior rotator cuff surgery
- A poor result (pain, weakness, loss of function) after anatomic shoulder replacement
- When a prior shoulder replacement becomes loose
- After a severe shoulder fracture that affects the humerus (arm)
- Shoulder instability after a prior anatomic replacement or large rotator cuff tear
- Other complex problems that can affect the rotator cuff and shoulder joint
- Failed repair of a massive rotator cuff tear
- Tumors that affect the shoulder joint area
What if I have already had surgery on my shoulder?
You may be a candidate for reverse shoulder replacement! Dr. Romeo treats all patients with shoulder problems, including those patients who have had surgery by another doctor and the results do not match the expected outcome. Sometimes this can be straightforward, such as treating a patient who has had one or more repairs of the rotator cuff and they still have pain and cannot raise up their arm. More complex cases included shoulder replacements that are too stiff; too loose and therefore dislocate; fractures that were repaired with a plate and screws but the shoulder still doesn’t work well; or patients suffering from an infection after prior surgery.
Patients regularly come to Dr. Romeo after a shoulder replacement or rotator cuff surgery that did not turn out how they expected, so we have developed treatment plans that can help even the most difficult shoulder problems.
More than 1/3 of Dr. Romeo’s cases are dedicated towards caring for patients who have had prior surgical treatment yet cannot live a comfortable, independent life. Combined with our comprehensive management plans is also a thoughtful approach to pain management and reduction of pain medication, as well as an integrated rehabilitation program that is designed to help you achieve your best potential result. Want to learn more? In this video, Dr. Romeo discusses when reverse shoulder replacement is the best answer for a rotator cuff tear problem.
How much difference will this make in my life?
Most patients will gain greater range of motion after the procedure and are able to return to activities that were not possible before the surgery. You can expect a significant pain reduction—perhaps even total elimination of shoulder pain in some cases. According to several studies, nearly 90% of reverse shoulder replacement patients have reported dramatic reductions in pain. Many of those reports looking at these results included Dr. Romeo’s own patients.
If a reverse shoulder replacement is done as a revision surgery, this may impact your results. Old scar tissue may interfere with your range-of-motion. Some minor pain or discomfort could persist, even after successful revision reverse total shoulder replacement. Dr. Romeo will take time before surgery to discuss your expected results so that you understand what is possible with these challenging procedures.
Reverse Total Shoulder Replacement Surgery Details
A reverse shoulder replacement has many similarities to a traditional shoulder replacement, including the preoperative evaluation, position during surgery, the surgical incision, and the postoperative plan for the first few weeks. However, there is one big difference: the placement of the ball and socket is reversed!
The normal shoulder joint is a ball-and-socket joint. The shoulder joint consists of a ball at the top of the arm bone (humerus) that fits into a socket (glenoid) at the shoulder blade (scapula). A reverse shoulder replacement uses an artificial device to replace the damaged shoulder joint in an opposite manner—it uses a ball at the shoulder blade and a socket at the top end of the arm. This is done to increase the stability between the shoulder blade and the arm so that patients without a functional rotator cuff can still get their motion and function back.
During surgery, a hole is made down the center of the arm bone to insert the stem of the socket implant securely into bone without the need for bone cement in almost all cases. A ball-shaped implant is fixed to the socket of the shoulder blade with screws. Proper alignment of these two pieces is critical to the success of the surgery, so Dr. Romeo will give you a specific prescription for CT scan so that he can use these images to plan and design the procedure on the computer before your day of surgery. Any imbalance will cause issues that can result in damage to the shoulder. Dr. Romeo believes in the carpenter’s proverb: “Measure twice, cut once.” His research and others has shown that the best chance to get a great result is making sure the first procedure has a plan and the plan is carefully carried out in the operating room. Want to learn more? In this video, Dr. Romeo demonstrates in the one hour live surgical procedure the principles and technique for a reverse shoulder replacement:
Outpatient Surgery for a Reverse Total Shoulder Replacement
Over the past 10 years, Dr. Romeo has worked with his anesthesia colleagues and nursing staff to develop methods to perform shoulder replacement procedures as an outpatient procedure. Initially, this was done in the hospital to ensure patient safety was the #1 priority as the transition was being made to allow patients to go home on the same day as their shoulder replacement.
With advances in both the surgical technique, and the anesthesia care, 1/3 or more of patients who are having a shoulder replacement can go home on the day of surgery, and in fact, many of these patients can be treated in an ambulatory surgery center (ASC). Dr. Romeo will talk to you about this option if you are a good candidate for the procedure. He and his colleagues have identified ideal patients to have this surgery, even reverse total shoulder surgery in an ASC.
During any of these procedures, whether at the hospital or in an ASC, he will take special care to use a multimodal approach to pain relief, a specific protocol to minimize the risk of infection, medication to lower the blood loss, and perform the procedure in less than 2 hours. All of these are factors that are associated with the ability to safely have the procedure in an ASC and go home on the same day to be with your family.
Want to learn more? In this video, Dr. Romeo discusses the value of Outpatient Shoulder Replacement surgery and the high patient satisfaction associated with this experience:
Recovery for Reverse Shoulder Replacement
Your recovery depends on whether this is your first surgical procedure or if you have unique challenges from previous surgery. It also depends on whether you had a fracture or prior severe rotator cuff problems with this shoulder. Dr. Romeo will discuss these issues in detail before the surgical procedure.
After the surgery, you are encouraged to move your fingers, hand, wrist, and elbow to help the joints remain soft and mobile and reestablish the full function of your hand. It is very important to do these simple exercises or the hand and fingers can get swollen, and that will slow down your recovery. In some cases, you will be taught pendulum exercises by Dr. Romeo or his staff to initiate simple movements in your shoulder.
For the first six weeks, no lifting or strenuous activities with your arm or shoulder are allowed so that your bone has time to grow into the metal surface of the prosthesis. During this time, the muscles and tendons near the new prosthesis will recover from surgery and you will restore the movement and function of your hand and elbow.
After six weeks of rest, physical therapy will begin. Physical therapy is different after a reverse total shoulder replacement. After a total shoulder replacement, patients begin physical therapy within the first week. But with a reverse total shoulder replacement, patients do not start therapy until after six weeks of rest.
If you have had prior surgery, your recovery period will be slightly longer. There is also an increased risk of infection and complications. Dr. Romeo uses current protocols to lower your risk of post-operative complications. Dr. Romeo participates and contributes to national and international conferences that establish the most effective treatment plans to avoid infection and postoperative complications, so you can rest assured that you will be treated with the most up-to-date methods supported by scientific evidence.
For more information about relieving shoulder pain and restoring motion with reverse shoulder replacement surgery—even for complex cases or revision surgery—please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
Shoulder Surgery Videos & Animations
Anatomy of the Shoulder as it relates to Surgery
Animation of Reverse Total Shoulder Replacement
Janet S., Reverse Shoulder Replacement
Additional Links on Reverse Shoulder Replacement
Want to know more? Here a few of Dr. Romeo’s recent medical journal articles about reverse shoulder replacement:
- Short-term evaluation of humeral stress shielding following reverse shoulder arthroplasty using press-fit fixation compared with cementer fixation: Journal of Shoulder and Elbow Surgery
- Influence of Glenosphere and baseplate parameters on Glenoid bone strains in reverse shoulder arthroplasty: BMC Musculoskeletal Disorders
- Reverse shoulder arthroplasty for proximal humerus fracture: a more complex episode of care than for cuff tear arthropathy: Journal of Shoulder and Elbow Surgery
- Finite element analysis of glenoid-sided lateralization in reverse shoulder arthroplasty: J Orthop Res
- Comparative Clinical Outcomes of Reverse Total Shoulder Arthroplasty for Primary Cuff Tear Arthroplasty Versus Severe Glenohumeral Osteoarthritis with Intact Rotator Cuff: A Matched-Cohort Analysis: American Academy of Orthopaedic Surgeons
- Irreparable Rotator Cuff Tears WithoutArthritis Treated With Reverse Total Shoulder Arthroplasty: Open Orthop J
- Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes: Orthopaedic Journal of Sports Medicine
- Salvage reverse total shoulder arthroplasty for failed anatomic total shoulder arthroplasty: a cohort analysis
- Comparative Clinical Outcomes of Reverse Total Shoulder Arthroplasty for Primary Cuff Tear Arthropathy Versus Severe Glenohumeral Osteoarthritis With Intact Rotator Cuff: A Matched-Cohort Analysis
- Tuberosity Repair in Reverse Total Shoulder Arthroplasty for Fracture Using a Stem-based Double-row Repair: A Cadaveric Biomechanical Study
- Outpatient vs. inpatient reverse total shoulder arthroplasty: outcomes and complicationsRevision Reverse Shoulder Arthroplasty
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.