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Get answers to your Shoulder and Elbow questions.
Learn more about this new procedure offered by University of Maryland Orthopaedics
What is the Reverse Shoulder Prosthesis?
It’s a shoulder joint replacement that is implanted into a person’s body when their own shoulder no longer functions properly or causes pain.
This procedure is designed for people who have exhausted all other means of repair. When a person gets to this stage of shoulder weakness and pain, changes must be made in the actual mechanics, or workings, of the shoulder.
Exactly how does the procedure work?
In the healthy shoulder, the upper arm bone (humerus) ends in a ball shape. This fits into a socket formed by the shoulder blade (scapula). Together this ball and socket form the shoulder.
With the Reverse Shoulder Prosthesis, the anatomy, or structure, of the healthy shoulder is reversed. The implant is designed so that the ball portion is attached to the scapula and the socket is placed at the upper end of the humerus.
The Reverse Shoulder System consists of five basic parts, or components. The upper portion of the humeral stem is called the epiphysis and it lies even with the top of the humerus. It is made of metal (titanium, cobalt chrome, stainless steel). The bottom portion of the humeral stem is called the diaphysis and it is inserted down into the center of the humerus.
The epiphysis holds the third component, a polyethylene cup that forms the socket part of the new joint.
On the scapular side, the fourth component, the metaglene, is a specially coated metal plate that is firmly attached to the scapula with screws.
The fifth component is the ball portion of the joint called the glenosphere. It is a half-globe shaped metal piece that fits onto the metaglene. The glenosphere fits inside the polyethylene cup on the humeral side to form a new shoulder joint. Both the glenosphere and the polyethylene cup come in different sizes so the implant may be tailored to different body sizes.
What conditions can be treated with the Reverse Shoulder Prosthesis?
The Reverse Shoulder Prosthesis is mainly used for older patients with rotator cuff tear arthropathy (end stage cuff tear arthropathy) a medical condition in which the rotator cuff muscles (the muscles around the shoulder joint) have degenerated, or weakened to a point where they can no longer hold the shoulder joint intact or allow it to function normally in conjunction with arthritis.
In many cases, the causes of the weakness may be arthritis, a previous shoulder injury such as a shoulder fracture, rotator cuff tear and/or failed previous shoulder surgeries.
This procedure can also be used in revision surgery, for failed shoulder replacement and shoulder fractures. It’s also commonly used for patients who don’t have a rotator cuff (pseudo-paralytic shoulder).
Who is the ideal candidate?
Older people who have significant pain and little to no movement in their shoulder are the best candidates. It is ideal for patients with chronic, longstanding rotator cuff tears with arthritis.
Is there anyone who should not have this procedure done?
This procedure is not recommended for people who have infections, deficiencies in the scapula, or for patients without functioning deltoid muscles. It is also not recommended for younger patients.
What are the benefits of the Reverse Shoulder Prosthesis?
Patients see a drastic difference in their range of mobility, and their ability to perform daily activities, such as eating, drinking, combing their hair, etc.
Patients who have had the procedure go from having severe shoulder dysfunction to 90 to 100 degrees full elevation.
When implanted by trained surgeons in the appropriate patients, the prosthesis provides restored motion, pain relief and increased stability.
When did this procedure receive FDA approval?
The procedure just received FDA approval in November 2004, but doctors have been using it in Europe for the past 20 years.
How long does the surgery take?
Typically it takes three hours, with a two-day hospital stay.
Would I need physical therapy after the procedure?
Patients will need outpatient physical therapy for about three months, which is about the amount of time it takes to recover from the surgery.
Why choose University of Maryland Orthopaedics?
We are one of the few hospitals in the United States that offers this procedure, and we're specifically equipped to handle this type of complex operation.
Patients benefit from our multidisciplinary approach to the treatment of shoulder disorders and have access to a full range of care. Our experienced team of physicians, certified physical therapists, and support staff all work together to help patients achieve success. In addition, our affiliated occupational and physical therapists are specially trained in rehabilitation of the shoulder and elbow prior to and after surgical reconstruction.
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