Before looking at the pros and cons of reverse shoulder replacement, it’s good to know how your shoulder anatomy would change after such a surgery.
There are two parts to the human shoulder socket. First you have the ball which is found at the top of the upper arm bone or humerus.
This fits tightly into a shallow, concave depression on the shoulder blade bone or scapula, named the glenoid socket.
The ball and glenoid socket in a healthy shoulder are covered in articular cartilage.
This is a type of tissue to protect the bones as well as letting the joint smoothly glide and move without pain or bone damage.
A reverse shoulder replacement means the ball and socket positions will be reversed. Where the glenoid socket was on the scapula, an artificial ball is adding.
Where the natural ball used to be at the top of the humerus, an artificial socket is attached.
Reverse Shoulder Replacement Pros
If your doctor has suggested reverse shoulder replacement as a solution for you, this likely means there are no other options to repair your damaged shoulder and get it functioning again.
The main reason to choose a reverse replacement rather than an anatomical replacement is if the rotator cuff muscles are damaged or torn.
These are the pros of this type of surgery:
- Patients can return to a pain-free life after surgery since function is restored enough for an active lifestyle.
- This surgery has a high success rate, meaning most patients will regain function of their shoulder within a few months.
- This surgery typically boasts a dramatic improvement from barely being able to lift the shoulder to returning to normal. This means patients should be able to use their shoulder properly again without pain or stiffness and they can sleep at night without shoulder pain waking them up.
Reverse Shoulder Replacement Con
Every surgery, no matter how large or small, comes with risks.
Complications can include shoulder dislocation, blood vessel or nerve damage, infection, or loosening of the new artificial joint.
Although this surgery is usually very successful in the right candidates, it is important to know there are risks regardless of how small.
That’s the only ‘con’ really and it probably won’t happen.
Why Rotator Cuff Muscles are Important
The 4 muscles making up the rotator cuff in a normal, healthy shoulder tightly hold the humerus ball to the glenoid cavity.
This keeps the ball and socket in the right position and keeps the joint stable.
The rotator cuff muscles stop the shoulder dislocating which can cause damage and pain. The shoulder joint has a wide range of motion thanks to the rotator cuff.
Over time these muscles can be injured or torn. If this happens, the muscle tendons won’t hold the humerus head tightly any more, resulting in joint instability.
It anatomical shoulder surgery, as opposed to reverse shoulder surgery, the humerus ball and glenoid cavity will be replaced using artificial components.
This is helpful if the illness is deterioration or disease of the shoulder joint cartilage.
However, if you have an ineffective rotator cuff, you can’t just replace those parts of the shoulder joint.
In that case, a reverse implant might be your best bet. Reverse shoulder arthroplasty has been around since 2004.
Before that time the only option was a standard shoulder replacement and that didn’t work for everyone.
This surgery has been around for long enough to show typically positive outcomes long-term in patients.
Orthopedic surgeons have increasingly chosen this type of surgery when there is complex pathology in the shoulder.
Great long-term viability along with high success rates mean reverse shoulder arthroplasties are more popular than ever and only increasing in popularity.
What is So Special about This Surgery?
If the anatomy of the shoulder is reversed, you won’t have a ball on the humerus which rotator cuff muscles have to hold in place tightly.
The ball portion of your joint is instead screwed into the scapula. This means your arm’s deltoid muscles will be able to replace the injured or weak cuff so shoulder movement can be regained.
Also, your natural glenoid socket where the natural ball goes is only a bit concave and shallow, so all shoulder stability would rely on the soft tissue integrity around the joint.
Manufactured shoulder implants for reverse shoulder are a constrained type of design.
Are You a Suitable Candidate for Reverse Shoulder Surgery?
You might be wondering whether you are suitable for this type of surgery. It might be beneficial if any of the following apply:
- Chronic shoulder dislocation
- Shoulder joint tumor
- A rotator cuff tear which can’t be repaired
- Internal joint derangement
- Glenoid socket complex deformities
- Poor function of the shoulder
- Not being able to lift your arm from your side or over your head along with excessive shoulder pain known as pseudoparalysis
- An anatomical shoulder replacement which is no longer working
- Arthritis caused by an unstable joint, or rotator cuff tear arthropathy
- Proximal fractures in the humerus which cannot be reconstructed
- Other treatments like rest, medication, cortisone shots, or physical therapy have not relieved your shoulder pain
What to Expect from Reverse Shoulder Surgery
Most patients are delighted they can return to a pain-free active life but bear in mind your shoulder might not feel the same way it did when you were in your twenties.
The reason is because the stability-producing dynamics which also reduce pain constrict the range of motion slightly.
The goal of the surgery is to give you your shoulder function back so you can enjoy an active lifestyle again. However, it’s important to be realistic.
A younger patient will probably be more disappointed with the surgery than someone elderly who will find it perfectly adequate for their daily activities.
Reverse shoulder surgery doesn’t mean you can start heavy lifting or throw a football like you did in college.
Limits which patients might have consist of inability to reach around the back as well as less strength if lifting overhead.
You will be able to do these things better after your surgery than before but not as well as when you were younger.