Reverse Shoulder Replacement
By Dr. Scott Stephens
The shoulder is one of the most complex joints in the body and its stability and function rely on the interplay between surrounding muscles and the smooth cartilage joint surfaces. The rotator cuff consists of four muscles that converge as tendons to cover the humeral head and are directly related to shoulder function and are a primary source for shoulder stability. These tendons can wear out over time with the normal aging process or be disrupted following a traumatic accident.
When rotator cuff tears involve multiple tendons and are of substantial size, they may not be repairable and the shoulder becomes weak and unstable. Over time this causes destruction of the normal joint surface of the shoulder and results in a unique form of arthritis known as rotator cuff tear arthropathy. This is a devastating condition that seriously compromises the comfort and function of a shoulder and can have a dramatic effect on a patient’s quality of life.
This differs from the more common form of arthritis, osteoarthritis, which erodes the cartilage surface but leaves the rotator cuff tendons intact and can be treated by a conventional shoulder replacement that mimics the normal anatomy and replaces the arthritic humeral head with a smooth metal “ball” and the glenoid with a plastic polyethelene “cup”. With rotator cuff tear arthropathy, the patient no longer has rotator cuff muscles to stabilize the shoulder or allow it to function and conventional shoulder replacements are unable to improve a patient’s function and may loosen over time requiring revision surgery.
To solve this problem, surgeons in Europe created an implant that reverses the biomechanics of a shoulder by placing the plastic polyethelene “cup” on the humerus and the smooth metal “ball” on the glenoid. This moves the center of rotation of the shoulder inwards towards the body and instead relies on the large deltoid muscle to power and position the arm overhead. The design of the implant also allows for increased stability of the shoulder by placing the polyethelene on the humerus which allows for a deeper, more constrained cup. After decades of success in Europe, the Food and Drug Administration (FDA) approved its use in the United States in 2003 and has demonstrated successful results since its inception here. This implant has also been successful for patients with failed conventional total shoulder and fractures involving the humerus.
The symptoms of rotator cuff tear arthropathy can be as small as discomfort sleeping on one side or as significant as severe pain and inability to raise your arm. This can result in an inability to perform simple daily activities such as fixing your hair, getting dressed, or reaching for an item on a shelf. After conservative treatment such as anti-inflammatory medications, physical therapy, and cortisone injections have failed to relieve pain and restore function for patients with this form of arthritis, reverse shoulder replacement provides outstanding pain relief and high patient satisfaction.
Dr. Scott Stephens graduated from John Carroll University in Cleveland, Ohio and received his medical degree from the University of Toledo School of Medicine. Dr. Stephens completed his orthopedic surgery residency in Columbus, Ohio at the Mount Carmel Medical Center. He went on to complete two yearlong fellowships in sub-specialty training including a sports medicine minimally invasive arthroscopy fellowship in Miami, Fl where he assisted in team coverage of the 2013 NBA champion Miami Heat. He then completed a prestigious fellowship in shoulder and elbow surgery in San Antonio under world-renowned surgeons Dr. Rockwood, Dr. Morrey, Dr. Wirth and Dr. Dutta where he was trained on all forms of shoulder replacements, including reverse total shoulder replacements. He is currently seeing new patients with OrthoNeuro at the Olentangy River Road, Pickerington, Dublin, and Westerville offices.