REVERSE SHOULDER ARTHROPLASTY
Dr. Geoffrey Connor

I tell patients with various orthopedic ailments every day, “It is my job to put the parts back together the way God intended them to be.” What I mean scientifically is, restoration of normal human anatomy is the objective which is most likely to result in satisfactory outcomes.

There is, in my mind, but one rare exception to this rule: shoulder arthritis caused by a long-standing rotator cuff tear. The medical term for this problem is Rotator Cuff Arthropathy. This type of shoulder arthritis creates a particular set of deformities in the joint that render it very difficult to use…even if repaired surgically by conventional methods! You see, in these cases, even if we restore the joint, in a fashion similar to knee and hip replacement, the muscles around the joint still don’t work, because they need a rotator cuff to do part of the job of moving the shoulder around. Well, that muscle and tendon unit has been gone for a long time and the end result is a painful, stiff shoulder….not the desired result from a major surgery, to be sure.

So, what to do? There is severe arthritis causing pain and disability and the muscle-tendon unit necessary to get good function – even with surgery- is missing. The answer – Reverse Shoulder Arthroplasty. This procedure is similar to conventional joint replacement in that it removes the painful cartilage surfaces and replaces them with metal and plastic, it is very different in that it changes the very nature of the joint. Another little thing I say to patients in this circumstance is, “We are going to take your shoulder’s ice cream and cone and turn it into a cone and ice cream.” That is to say, we flip the joint. We take the ball joint of the arm and turn it into a socket. We take the socket of the wing bone and turn it into a ball.

Why? Well, in the face of my maxim above, this is the rare case where the natural anatomy of the human body is no longer able to get the job done. By reversing the orientation of the shoulder joint, we are able to move the center of rotation of the shoulder out laterally, allowing the intact deltoid muscle to do the job that the rotator cuff is no longer able to do. In layman’s terms, we are taking the slack out of the line so the muscles have something to pull on. Again, this situation is thankfully somewhat rare, but if you’ve been told that there is nothing that can be done about your painful, arthritic shoulder, give me a call, it is quite possible that all is not lost, Reverse Shoulder Replacement may be the answer.