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>> 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.
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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.
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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.
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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.
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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.
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