Reverse Shoulder Replacement

Dr. Brian Forsythe, Dr. Gregory Nicholson, Dr. Brian Cole and Dr. Nikhil Verma are among a select group of physicians nationwide who perform reverse shoulder replacement surgery.

What is reverse shoulder replacement?

As the joint with the most mobility of any other in the body, shoulders have a great risk for injury and painful conditions. This can often lead to joint replacement, which is a growing procedure in the United States. However, sometimes patients who have had shoulder replacement or rotator cuff surgery are still in pain and have limited mobility. A revolutionary type of surgery, known as reverse shoulder replacement, is a new treatment for these patients who have suffered for years with no solution available. Reverse shoulder surgery provides the potential for improved elevation and mobility of the arm and greater pain relief.

Developed in France in the mid-1980's, reverse shoulder replacement studies cite a more than 90 percent success rate when performed by highly skilled and experienced surgeons. Shoulder physicians at Midwest Orthopaedics at Rush (MOR) are well respected in the industry for their cutting-edge research in reverse shoulder replacement surgery. Some of them were involved in the investigation and design of the first reverse prosthetic implant prior to FDA approval in 2004. MOR shoulder physicians perform hundreds of reverse shoulder procedures each year.

The shoulder joint is a ball-and-socket joint that consists of a ball at the top of the arm bone (humerus) that fits into a socket at the shoulder blade (scapula). A reverse shoulder replacement uses an artificial device to replace the damaged shoulder joint in a reversed manner — a ball at the shoulder and a socket at the end of the arm. The shoulder physician creates a hole down the center of the arm bone, inserts the stem of the socket implant and secures it with special cement. A ball-shaped implant is affixed to the socket of the shoulder blade using screws. Proper alignment of these two pieces is critical to the success of the surgery. Any imbalance will cause rotation issues that can result in damage to the shoulder.

What makes this procedure unique is that it is often the only option for conditions of severe arthritis, significant tears to a rotator cuff and/or failed rotator cuff or total shoulder replacement surgery. A rotator cuff is a group of muscles and tendons that wraps around the shoulder and connects the arm bone to the shoulder blade. The rotator cuff does all the lifting and rotating for the shoulder and when damaged, it can result in debilitating immobility of the joint. The reverse shoulder replacement offers a substitute for the absent action of the rotator cuff by making the deltoid muscle on the outer shoulder do the work.

Who is a candidate for reverse shoulder replacement?

Reverse shoulder replacement is an invasive procedure with risks. Shoulder specialists at Midwest Orthopaedics at Rush are highly skilled in identifying those who would benefit most from this procedure. They are Chicago's premier shoulder physicians committed to performing reverse shoulder replacement only in ideal candidates who qualify for it with one or more of the following:

  • Have a completely torn rotator cuff or failed rotator cuff
  • Have severe arthritis (cuff tear arthropathy)
  • Previous shoulder replacement that failed
  • Are an older person with significant pain and little to no movement in the shoulder
  • Have no other viable options for treatment

If a patient is prone to the following, reverse shoulder replacement is not an option:

  • Infections in the joint
  • Scapula deficiencies
  • Non-functioning deltoid muscles

What can be expected from reverse shoulder replacement?

Reverse shoulder replacement surgery is an inpatient procedure that usually takes less than two hours. Patients remain in the hospital for two to three days. A sling will be used to restrict movement for up to six weeks.

Extensive physical therapy is not needed following this procedure. Three months of outpatient therapy, often at home, is all that is needed and is about the same amount of time it takes to recover from surgery.

Patients are encouraged not to overuse the shoulder too quickly because it jeopardizes the strength, mobility and stability of the implants forming the new joint. A reverse shoulder replacement surgery will restore a patient's range of motion and alleviate pain. However, it will not allow a patient to do rigorous high-impact activities, lift weights or acceleration/deceleration activities such as chopping wood and shoveling snow. It will allow patients to golf, swim, jog, play tennis and perform normal daily activities. Most patients can return to these activities about four months after surgery.

MOR's award-winning doctors are among the most skilled in diagnosis and treatment of shoulder conditions. They have a top team of professionals including nurses, anesthesiologists, physical therapists, surgeons and staff — all of whom are committed to treating patients with respect and excellence.

Janet Streenz, a dance instructor from Bloomington, Illinois, is raising her arms again after having reverse shoulder replacement surgery at Midwest Orthopaedics at Rush. Streenz, 72, struggled with shoulder pain and arm mobility problems resulting from failed rotator cuff surgeries. But MOR shoulder physician Dr. Anthony Romeo performed the relatively new reverse shoulder surgery. Now the pain is gone and Streenz is back teaching classes and dancing again.