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Reverse Shoulder Replacement | Johns Hopkins Medicine

February 15, 2020

(soft electronic music)>>A shoulder replacement
is a surgery designed to help people with arthritic shoulders. An arthritic shoulder is one
where there’s no cartilage and there’s bone on bone. It’s characterized by pain and loss of motion and loss of function. So, a standard shoulder replacement is designed to replace
the anatomy as it exists. So, the way it works is your shoulder’s a ball-and-a-socket joint, so this is your arm bone, your humerus. At the top is a ball, which
is called the humeral head. So, in the standard anatomical
shoulder replacement, we call it, we take off the
existing ball on the humerus and replace it with a metal ball. We also, in order to make it stay put, we put a stem down the humerus, which is here, it’s a metal stem, and then we place the
humeral head on like this, so it’s a modular thing so that it can fit the anatomy as it was before. On the socket side, what we
do is we cover the socket with a plastic piece, and
that’s essentially cemented in. It can be either a
keeled kind of component or it can have pegs, like this component, and as a result, when
it’s all said and done, you end up with a ball articulating, or in the joint, with the socket. So, it essentially replaces
the normal ball-and-socket, so that you, again, have metal on plastic and that gets rid of the pain. (soft electronic music) So, a reverse shoulder replacement is exactly like it sounds. In a normal shoulder, you
have the ball on the arm side. In a reverse arthroplasty, the ball actually is on the socket side. So, this is the shoulder
blade, this is the ball which would normally
be on the humeral side. So, what happens is on the humeral side we still have the stem down
the center of the humerus, but there’s a plastic
piece on the humeral side instead of on the socket side. So, instead of the ball
being on the humerus, it’s, again, on the socket side, so when you put it all together,
the two match very nicely so that they stay together. This essentially eliminates the pain also because you don’t have
bone on bone any longer, but you have metal on plastic. In that sense it’s similar
to a standard replacement except, again, the ball
is on the opposite side or on the reverse side of a
standard shoulder replacement. (mellow electronic music) There are several reasons to have a reverse total-shoulder replacement as opposed to a standard
anatomical shoulder replacement. The most common reason is when the rotator cuff tendons
are torn to the extent that they can’t be repaired surgically. In that case, sometimes
people also get bad pain or bad arthritis which
accompanies the rotator cuff tear, and the reverse arthroplasty allows the shoulder to function normally. In a standard replacement, if
you don’t have a rotator cuff, it can lead to early failure. The good thing about a reverse
is it’s actually designed for people who have a torn rotator cuff. The other group of people
that it’s very good for is people who have worn the
bone away on the socket side. With a standard replacement,
you need enough bone to be able to place the
component with the pegs so that they stay cemented in place. Sometimes that’s very
difficult to accomplish, so the good thing with
a reverse arthroplasty is it can be used in patients
who’ve lost a lot of bone. For example, this is a scapular model of someone who has lost a
significant amount of bone in their socket. The socket should be perfectly flat here, but you can see that it’s very dished out and there’s a lot of bone missing. With reverse arthroplasty, you can place the baseplate
and the ball on the socket side without too much difficulty,
and it’s very effective in terms of getting rid of pain and helping people resume
or get back their motion. There are other reasons for a
reverse arthroplasty as well. Sometimes people have fractures
that need to be fixed, or fractures that have
healed in the wrong position that are best treated with
a reverse arthroplasty. Also, people who’ve had
longstanding arthritis to, say, rheumatoid arthritis or to multiple dislocations
in the shoulder. Many of these patients
were not able to be helped very effectively with standard
shoulder replacements, which now, these days,
with reverse arthroplasty, can be treated quite nicely and they get very excellent
pain relief and function. (soft electronic music) So, as far as the recovery of shoulder replacement
surgery is concerned, the good thing is that, particularly with a reverse arthroplasty, you can be up and around
almost right away. There’s really not as much pain
with a shoulder replacement as with other major joint replacements, such as knee replacements
or hip replacements. As a result, patients typically
don’t need as much medicine and don’t have as many
side-effects of the medicine. So, we let people start
using their arms right away, and they can usually feed
themselves within a few days. So, the ability to recover
from a shoulder replacement’s quite good compared to
other joint replacements. Typically I admit patients
for at least one night after surgery to make sure that there’s no trouble
with pain or medical issues. Most patients don’t bleed
enough to need a transfusion, so transfusions after
shoulder replacements are quite uncommon. Most people are up and
around within a day or two. We usually discharge patients
after two nights if necessary. Most people can feed themselves,
again, within several days. Most people can drive
within two to three weeks, so recovery from a shoulder replacement, including a reverse replacement,
is really quite short. (soft electronic music) One of the great advantages of a reverse total-shoulder arthroplasty is it allows us to take care
of problems around the shoulder that we’ve not been able to
take care of in the past. Particularly, things
that we can take care of are failed shoulder surgeries, including failed previous
shoulder replacements. Fortunately, shoulder replacements
don’t fail very often, but when they do, the surgery
could be somewhat complex and we are able now, at this point, to be able to replace
any shoulder replacement to provide more function for the shoulder that has previously failed. Also, a reverse arthroplasty can be used for people who’ve had failed
fixation for fractures or for fractures that have
not healed appropriately, and a lot of other indications that the standard shoulder replacement was not as good at taking care of. (soft electronic music)

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