Reverse Shoulder Replacement

[mtomaino]

When glenoid wear results in pain and loss of motion, the ideal next step would be a revision to a total shoulder replacement---an "anatomic " design. This would amount to resurfacing the glenoid with a plastic implant to allow the metal "ball" to articulate with the socket without pain. This, however, requires a functioning rotator cuff and adequate bony anatomy to allow fixation of this type of design.

Unfortunately, in many of these "revision" cases, the metal ball has, over time, worn into the socket so much that a new socket forms---a so called "pseudoglenoid"---and this requires special attention to reshape the socket so as to accomodate a new glenoid component.

In such cases, years of poor motion often lead to deconditioning of the rotator cuff muscle as well. The most optimal functional result in cases such as these involves a nonanatomic design---Reverse shoulder replacement. This involves removal of the previous implant and placement of the new reverse implant. The deltoid muscle, which is healthy in these cases, allows restoration of forward elevation. External rotation is usually possible if the teres minor muscle is functioning; when not, a tendon transfer may be recommended.

These cases are indeed, major and complex, but if all goes according to plan, very good pain relief and improved function can result.