Rotator cuff disease that arises from glenohumeral arthritis is probably the top condition that calls for a reverse shoulder arthroplasty. Reverse shoulder replacement was specifically designed for a problem called rotator cuff tear arthropathy. Rotator cuff tear arthropathy is a problem that occurs when a patient has both shoulder arthritis and a rotator cuff tear. This surgery also helps correct irreparable anterosuperior cuff tears in the elderly, the proximal humeral fractures in elderly, significant glenoid defects and as a revision procedure for a failed hemiarthroplasty and total shoulder arthroplasty. The anterosuperior approach is a surgical approach used in reverse shoulder arthroplasty. This technique is a combination of the earlier used transacromial approach and the anterosuperior approach that is used for shoulder arthroplasty. The anterosuperior approach has better postoperative stability when compared to the classic deltopectoral approach.

The anterosuperior approach is a preferred technique in primary and revision reverse shoulder arthroplasty and also for acute humeral head fracture. In the case of the anterosuperior approach the patient is positioned in a similar manner. But in this method the elbow has to be free of any support to enable a proximally directed force at the elbow so the proximal subluxation of the humeral head is possible. The skin incision begins on the anterior part of the acromioclavicular joint and it is directed toward the front edge of the clavicle, stretching few meters behind the anterior acromion and beyond the lateral side of the acromion. This approach though will spare the subscapularis which has inconsistently resulted in lower dislocation incidences. This approach offers a better end-on view of the glenoid, the option of subscapularis preservation while enabling accurate placement of implants, earlier return to function, and a lower rate of postoperative instability.

When compared to the deltopectoral approach, the anterosuperior approach offers the advantages of better conditions of release and fixation of the greater tuberosity. Some other advantages of this technique are simplicity, ease of axial preparation of the humerus, quality of the frontal exposure of the glenoid, and preservation of the subscapularis tendon.

The anterosuperior approach has found to be especially useful for total shoulder replacement as well because it gives excellent face-on view of the glenoid for accurate preparation and implantation of a glenoid component. The other approach may not offer a satisfactory exposure of the glenoid in the well-muscled. The anterosuperior approach splits the anterior third fibers of the deltoid while protecting the cephalic vein and also ensuring that there is no damage to the axillary nerve.

Reverse shoulder arthroplasty is recommended when there is an irreparable anatomic or functional destruction of the rotator cuff along with an unstable center of rotation for the glenohumeral joint. The other prerequisites for this type of surgery are that the deltoid muscle is well functioning and that there should be adequate glenoid bone. Age is another important factor when reverse shoulder arthroplasty is being considered. Reverse shoulder arthroplasty should be limited to elderly patients that may be 70 years and older, with poor function, low activity, and severe pain in the presence of sufficient quantity and quality glenoid bone capable of providing unyielding fixation of the prosthetic glenoid component.

Q&As on Reverse Shoulder Arthroplasty

1.What is reverse shoulder arthroplasty?

Reverse shoulder arthroplasty is a type of orthopedic surgical procedure in which the damaged bone of your shoulder joint is replaced with a prosthesis. It utilizes the convex glenoid hemispheric ball and a hollow humerus articulating cup for the reconstruction of the glenohumeral joint. This inventive method offers substantial relief from shoulder pain and enhances the range of mobility in your shoulder. It is most commonly done for the treatment of conditions such as rotator cuff tear arthroplasty, fractures caused by displacement of the proximal humerus, and failure of shoulder arthroplasty.

2.For which conditions is reverse shoulder arthroplasty used as treatment?

Reverse shoulder arthroplasty is effective for the treatment of the following conditions:

  • Rotator cuff arthroplasty, a degenerative shoulder disease caused by a massive rotator cuff tear, leading to arthritis glenohumeral joint alterations and migration of the proximal humerus
  • Pseudo paralysis of the shoulder caused by irreversible massive rotator cuff tear
  • Fractures such as acute multiple parts proximal humerus
  • Glenohumeral arthritis caused after trauma
  • Chronic irreversible shoulder dislocation
  • Repeat surgery for failure of proximal humerus hemiarthroplasty
  • Inflammation of joints, such as rheumatoid arthritis.
  • Tumours in the shoulder joint

Reverse shoulder arthroplasty becomes an option when pain and weakness start affecting day-to-day activities. If conservative treatments such as medicines, physical therapies, and injections fail, surgery is the only option. Rehabilitation and precautionary measures after surgery must be properly followed. These primarily include home exercise routines, prevention of sudden body movements, especially of the arms, proper rest, good diet including many others.

3.What care should be taken after reverse shoulder arthroplasty?

After surgery, intravenous antibiotics and some pain medications are given. Most patients can start taking solid food and moving the day post surgery. Discharge from the hospital is allowed on the second or third day post operation based on the patient’s comfort level. Rehabilitation and precautionary measures after surgery must be properly followed. These primarily include home exercise routines; prevention of sudden body movements, especially those of arms; and avoiding excessive rehabilitation exercises and heavy lifting. Any movements that put pressure on your shoulder joint must be avoided.

4.What you should expect from reverse shoulder arthroplasty?

Reverse shoulder arthroplasty surgery takes about 3 to 5 hours for completion. As the bones require time for healing near the implants, movement of the shoulder is limited for several days to weeks after the procedure. Like all surgeries, there are certain risks associated with this orthopedic procedure, such as:

  • Infections
  • Clotting of blood
  • Dislocation
  • Damage of nerve

Regarding the effectiveness of the procedure, even if it does not reestablish the complete range of motion in the patient, it is effective in offering relief from pain and enhancing the range of motion to some extent. It will take around 4 to 5 months for complete recovery. And new implants last for about 15 years before they require any fixing or replacement with repeat surgery.

5.What are the benefits of reverse shoulder arthroplasty surgery?

There are numerous advantages of reverse shoulder arthroplasty, such as:

  • The center of rotation progresses inferiorly and is medialized.
  • This surgical procedure facilitates the deltoid muscles to work on a long fulcrum and possesses more mechanical benefits for substituting the scarce rotator cuff muscles for offering abduction of the shoulder.
  • It does not substantially assist shoulder rotation, either internal or external.
  • It can be mixed with latissimus dorsi transfer to help with rotation.
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