Reverse shoulder replacement was introduced in the United States in 2004 after its launch in Europe in the 1980s. The initial indication for this procedure was an irreparable rotator cuff tear in an arthritic shoulder with the inability to raise the arm against gravity (pseudoparalysis). Since that time, newer implant designs and a better understanding of durability, complications, and failure mechanisms have expanded the indications for reverse shoulder replacement to include a host of other conditions for which it may be the best option. Here are five reasons a shoulder surgeon may choose the reverse prosthesis.
Age: at a certain point in time, the soft tissues around the shoulder either do not heal well or are at risk of tearing. Performing an anatomic shoulder replacement in patients >75 – 80 years may risk eventual cuff tear or failure of the tendon repair that is part of the surgery. In such cases, patients may have to undergo revision surgery. As such, many surgeons have gravitated to just performing a reverse in the age group regardless of diagnosis to avoid the risk of later cuff failure.
Sever bone wear: advanced osteoarthritis can cause severe bone wear that can lead to biomechanical changes to the joint. Correcting such wear with an anatomic prosthesis can be difficult and lead to a higher risk of implant failure due to poor fixation in the remaining bone. The reverse implant is more tolerant of bone loss and can achieve better fixation in limited bone.
Rotator Cuff Disease: in patients who already have a rotator cuff tear in the setting of arthritis or have an intact but weakened rotator cuff, reverse replacement is preferable to improve function and prevent the likelihood that the rotator cuff disease will prevent an issue. The reverse can also be used in patients with irreparable, large rotator cuff tears than without arthritis.
Inflammatory Arthritis: patients with rheumatoid arthritis, erosive osteoarthritis and other forms of inflammatory arthritis are at a higher risk of developing a rotator cuff tear after a standard reverse replacement and are better served with a reverse replacement to avoid issues related to late cuff tears in this setting.
Fractures: for some severe fractures of the shoulder joint, reconstruction with the reverse replacement has become the treatment of choice that results in the best functional outcomes compared to standard replacement or attempts at repairing the fracture.
Currently, in the United States and around the world, reverse shoulder replacement now accounts for about 70% of all shoulder replacements. As such, the procedure has undergone significant advancements in implant design with a view toward improving functional outcomes and durability. When considering a shoulder replacement, patients should choose a surgeon who has substantial experience with this procedure and performs them regularly as higher volume surgeons have better outcomes and lower complication rates.
Dr. Parsons placed the first reverse shoulder replacement in New Hampshire in 2004 and was one of the first surgeons in the country trained in this technique. Since that time he has performed over 600 of these procedures and has worked on implant design and surgical navigation systems to improve the outcomes of this procedure.