Christopher Jones, MD
In 2003 the FDA finally approved the use of the Reverse Total Shoulder Replacement on patients in the United States. This procedure had been performed in various forms in Europe for at least 20 years prior to this. The FDA had good reason to delay its approval since the learning process for the European surgeons of figuring out what would work and what would not work was less than smooth sailing. There were some catastrophic failures with the initial designs including fractures, dislocations, and components breaking.
The Reverse Total Shoulder Replacement is designed to be used for patients without a functioning rotator cuff. This procedure offers these patients an excellent option for treatment that will provide them with significant pain relief and improved function. Prior to having the Reverse TSA, we did not have any good options to offer these patients. After surgery, patients typically go from being in constant pain to reporting little to no pain at all within weeks of undergoing the procedure. Additionally, they have dramatic improvements in function. Many patients cannot lift their arm above shoulder height before the procedure and can elevate fully overhead after it is performed.
The basic design philosophy was to change the shoulder from a completely unconstrained joint to a semi-constrained joint in order to allow it to function without a rotator cuff. One of the main functions of the rotator cuff (RC) in the shoulder is to keep the ball centered in the socket as the shoulder moves through range of motion. Without the rotator cuff, the ball would simply rise out of the socket because of the upward pull of the deltoid (D) and lock under the acromial process of the scapula.The Reverse TSA switches the ball and socket to place the ball on the socket (glenoid) side of the joint and the socket on the ball (humeral) side. This not only creates a semi-constrained joint, but increases the lever arm for the deltoid muscle and thus, improving its power. The increase in lever arm is a vital component of this design as it is the only muscle that these patients have left that can lift their arm.The Reverse Total Shoulder Replacement is one of my favorite procedures to perform because the patients do so well. The recovery does not follow the typical course of most shoulder procedures where it takes 6-12 months to realize the benefit of having the surgery. These patients are often better than before surgery by 3-6 weeks. For the straight forward reverse TSA, the patient is only required to where a sling for 3 weeks. After this period they simply start using their arm and often see improvements in function from their pre-operative status as early as 6 weeks.
If you would like to learn more about this amazing procedure and if you are a candidate, I am happy to evaluate you and discuss further.