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
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
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.
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.