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Reverse Shoulder Replacement

An innovation in shoulder replacement has made shoulder joint implantation a success for patients who have shoulder arthritis due to rotator cuff damage that cannot be repaired.   This group of did not have a good option in restoration of shoulder function in the past.

Since 2012, Virtua Willingboro Hospital has been providing patients with reverse shoulder replacement, switches the ball-and-socket configuration of the joint, using artificial components to replace the natural socket on the shoulder side with a ball and the natural ball at the top of the arm with a humeral head that has a concave cup.  This changes the center of rotation so the joint is less likely to shift after surgery, with the deltoid muscle providing the primary movement without the stabilizing force of the rotator cuff.

Virtua performs a far higher volume of reverse shoulders than
the vast majority of programs.

To be candidates for the procedure, patients must have severe arthritis in the shoulder causing pain and/or inability to lift the arm above the shoulder or head.   If conservative treatments cannot resolve symptoms and the rotator rotator cuff is non-repairable, individuals can be considered for reverse shoulder replacement.

Patients who are good candidates for this procedure have often torn their cuff 10 or 20 years earlier and have continued to lose function in the shoulder during that time to the point where they may not be able to do simple activities, such as reach high enough to do their hair or get a dish out of a cupboard. Most patients are over 60 years of age.

reverse shoulder illustration

Shifting Center of Rotation for Stability and Strength

In the normal shoulder, muscles and tendons of the rotator cuff, help balance and hold the ball of the arm bone in place where it rests against the socket, countering the upward pull of the deltoid muscle. In a patient with major rotator cuff destruction, the ball at the top of the arm escapes out of the socket during arm elevation.

Reconstruction with a reverse shoulder joint moves the center of rotation of the shoulder to correct this problem. The deeper socket prevents the joint cup (now on the arm) from sliding up and down as the arm is elevated. The surgeon screws the ball plate into the bone of the shoulder blade and cements the prosthesis that holds the cup into the arm bone.

Improved Joint Resolves Pain and Returns Function

shoulder prosthesis pic and x-ray

Shoulder degeneration after lost rotator cuff function affects men and women who have a predisposition to the problem and/or active lifestyle or repetitive trauma. The reconfigured joint anatomy after a reverse shoulder replacement adds long-term stability and gives the deltoid muscle the tension sufficient to power the shoulder.

Expected outcomes for patients include:

  • Improved range of motion
  • Improved function and ability to perform daily activities
  • Significant shoulder pain relief

An experienced Virtua team offers the reverse shoulder surgery at Virtua Willingboro Hospital, where it is currently completing about 70 such operations per year–a far higher volume of reverse shoulder procedures than the vast majority of programs. The procedure also can be used for revision surgery after failed shoulder replacement or shoulder fractures.

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