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more articles by Young, Brett , MD  |  author's bio

New Approach to Shoulder Replacement Surgery

Innovations in Orthopedic Surgery

By Brett Young, MD


There have been a number of significant developments in joint replacement surgery in recent years. One important advance for people with badly arthritic or seriously injured shoulders is reverse shoulder replacement surgery. This surgery, which was developed in France, has received FDA approval and is now available locally at Cayuga Medical Center.


When is shoulder replacement surgery appropriate?


People typically consider shoulder replacement surgery when lifting the affected arm has become so painful it adversely affects your quality of life. It may be difficult or impossible to accomplish simple tasks such as combing your hair or taking a dish from an overhead cupboard. When other more conservative treatment options have been exhausted, such as physical therapy and arthroscopic repair, it makes sense to discuss shoulder replacement surgery with your doctor.


What are the most common causes of disabling shoulder pain?


There are three common causes of disabling shoulder pain in people who may be candidates for shoulder replacement surgery: severe arthritis; a completely deficient rotator cuff, which typically prevents you from lifting your arm above your shoulder; and a badly fractured proximal humerus, which occurs when the shoulder is broken at the top of the arm bone where the ball of the joint fits into the socket. This type of injury is referred to as a fragility fracture and occurs most often in post-menopausal women who have osteoporosis and whose bone is so badly shattered it can’t be pieced together again.


How is reverse shoulder replacement different from standard should replacement surgery?


The shoulder is a ball-in-socket joint, with the ball located at the top of the humerus (the arm bone), and the socket (glenoid) located in the shoulder blade. The rotator cuff muscles connect the ball and the socket and assist the large muscles of the arm.


In a conventional replacement procedure, the surgeon replaces the ball at the top of the arm and the socket in the shoulder blade. However, in a reverse shoulder replacement the location of the ball and socket are switched, with the ball attached to the shoulder blade and the socket attached to the upper arm bone. In this scenario, the socket pivots around the new ball.


When is it appropriate to consider a reverse shoulder replacement?


Standard shoulder replacements require a properly functioning rotator cuff. When a patient has both severe arthritis and an irreparable rotator cuff tear, reverse shoulder replacement is the most viable treatment option because it allows the patient to raise the arm without having a rotator cuff. The reverse replacement procedure is also appropriate when a prior attempt to repair a fractured shoulder with metal plates and screws has failed due to bone fragility. Finally, if a previous shoulder replacement has failed, the reverse shoulder replacement may successfully restore mobility.


Patients going into reverse shoulder replacement surgery have significant shoulder pain. This new procedure provides reliable relief from pain and improved function. While it will not restore the shoulder to a completely normal range of motion, it should enable you to resume activities of daily living. If you suffer from severe shoulder pain and have been told there is nothing else to be done, reverse shoulder replacement might be a good option to explore with your doctor.


Dr. Young is an orthopedist at Cayuga Medical Center and is in practice with Orthopedic Services of Cayuga Medical Associates, where he can be reached at (607) 272-7000. He completed fellowship training in shoulder and elbow surgery at New York University Hospital for Joint Diseases.













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