Reverse total shoulder arthroplasty is a unique surgical solution designed originally for patients with pain and dysfunction from advanced glenohumeral joint arthritis associated with severe rotator cuff deficiency either after an unsuccessful repair or in the setting of a chronic tear that has become irreparable. In the normal shoulder, the rotator cuff and deltoid muscles work together to elevate the arm. However, with massive rotator cuff tears and advanced degenerative joint disease, the normal mechanics of the shoulder are disrupted, making arm elevation difficult if not impossible.
 
However, as I will show in the text below, and in Video attestations, Reversed shoulder arthroplasty has additional indications in 2011.

The reverse shoulder prosthesis provides a fixed fulcrum for the shoulder joint that allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm. Although the original "Grammont" design was truly nonanatomic, with a medial center of rotation and a valgus humeral inclination, a more "anatomic" reverse design is commercially available through DJO--having been extensively investigated and published about by its designer, Dr Mark Frankle. This design has a role in my practice because of its potential for improving range of motion and minimizing scapular impingement.

A few years ago Reverse total shoulder arthroplasty was still in its infancy, and a number of issues needed to be resolved with this procedure. Over the past few years implant designs have improved, and surgical pearls and pitfalls have been more clearly defined such that with thorough patient evaluation and careful patient selection, complications can be minimized, and satisfactory pain relief and increased range of motion can be achieved in most patients.

In short, aside from performing a Reverse as a revision procedure for a failed previous replacement the indications for Reverse arthroplasty include:
1. Osteoarthritis with a poorly functioning rotator cuff (due to tearing or disuse atrophy)
2. Rotator cuff arthropathy----arthritis secondary to a chronic rotator cuff tear
3. Failed Rotator Cuff Repair with pain and loss of function (but no arthritis)
4. Fracture Nonunion (no arthritis, but as an alternative to hemiarthroplasty or bone-grafting procedure
5. Acute Fracture when repair is contraindicated and concern about tuberosity healing, poor bone quality, or advanced age contrindicate Hemirthroplasty
6. Fixed shoulder dislocation

As one of a select few shoulder surgeons in Rochester who perform this type of replacement, I have had the privilege of helping many  patients regain the ability to raise their arm overhead--even after years of not being able to do so.  In addition, this is an option to revise painful replacements, after which pain has developed or persisted and/or when function has deteriorated.

If you think that you may be a candidate for this procedure, please feel free to contact me for more information

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