Reverse Shoulder Replacement

Reverse Total Shoulder Arthroplasty is an innovative surgery in which the anatomical configuration of classical shoulder prosthesis is reversed. Normally, the ball is on the scapular side and socket on the arm side; in reverse prosthesis, this relationship is inverted. This allows arm elevation using the deltoid muscle without needing rotator cuff muscles. The gold-standard treatment for irreparable massive rotator cuff tears + arthritis (cuff tear arthropathy), complex humeral fractures, and revision cases. Usually applied in patients over 65-70 years.

Symptoms

Characteristics of reverse prosthesis candidates:

• Irreparable massive rotator cuff tear
• Accompanying advanced shoulder arthritis (cuff tear arthropathy)
• Inability to raise arm above shoulder level (pseudoparalysis)
• In elderly patient (usually >65), complex proximal humerus fractures
• Failed previous prosthesis or repair
• Severe pain + advanced function loss

Diagnostic Methods

Begins with detailed clinical examination. X-rays show arthritis degree and "high position" (superior migration of humeral head). CT is critical for bone quality, glenoid (socket) status, and preoperative planning. MRI evaluates rotator cuff status. In some cases, 3D CT is used for computer-assisted planning.

Treatment Approach

Non-Surgical Treatments

All conservative methods must be tried before surgery: physical therapy, NSAIDs, intra-articular injections. If these are insufficient and patient is a suitable candidate, prosthesis is planned.

Surgical Treatment

In surgery, upper humerus and glenoid bones are resected and prosthesis metallic and polyethylene components are placed. Glenosphere (sphere placed on scapular side) and humeral cup (socket placed on arm side) are the basic parts of reverse prosthesis. Bone grafting is used if bone defects exist. Modern computer-assisted techniques (PSI) increase implant placement accuracy.

Surgical Process

Performed under general anesthesia + interscalene block, patient in semi-seated position. Procedure lasts 2-3 hours.

Hospital Stay

2-3 overnight hospital stay is typical.

Recovery Process

• Weeks 0-4: Arm sling, passive exercises allowed
• Weeks 4-8: Active-assisted exercises begin
• Months 2-4: Active exercises, gradual strengthening
• Months 4-6: Full function, return to daily activities
• Sports return: Contact sports not recommended; swimming, golf, cycling suitable

Return to Work

Desk work in 4-6 weeks, light physical work in 3-4 months. Most patients are already retirement age. Permanent restriction recommended for heavy work or carrying loads over 5 kg.

Potential Complications

Prosthesis surgery complication rate is 10-15%. Possible problems: instability/dislocation (2-5%), infection (1-3%), acromial bone fracture, neurological complications (usually temporary), prosthesis loosening (long-term), heterotopic ossification.