For many individuals with painful shoulders caused by arthritis, injury or other afflictions, reverse shoulder replacement has made shoulder replacement surgery far more effective. First approved in the U.S. in 2004, the procedure is ideal for patients whose damaged rotator cuffs render them ineligible for anatomic shoulder replacement, the traditional approach.
“Many people still think of shoulder replacement as being painful and ineffective, and that’s because in the past the anatomic procedure was often used to address a diagnosis for which it was not appropriate,” says UCLA orthopaedic surgeon and sports medicine physician Frank Petrigliano, MD. “Now that we can also offer reverse shoulder replacement, surgeons can indicate the best procedure for a given patient. As a result, the outcomes for both surgeries have improved dramatically.”
The conventional anatomic shoulder replacement tends to be effective only for individuals with shoulder arthritis and a normal rotator cuff, Dr. Petrigliano says. The reverse procedure — so named because the surgeon replaces the shoulder joint’s ball and socket while switching their positions — is the best option for most other cases. These include patients with shoulder arthritis in which the rotator cuff is torn, patients with severe fractures that can’t otherwise be repaired, patients with previous shoulder replacements that are no longer effective and those with severe rheumatoid arthritis and advanced osteoarthritis.
Although it remains less common than hip and knee replacements, shoulder replacement is growing at a faster pace, due to the ability of the reverse procedure to relieve shoulder pain for conditions that were inadequately addressed by the anatomic approach. Last year, there were more than 53,000 total shoulder replacements in the U.S., Dr. Petrigliano notes. UCLA is among the highest-volume shoulder replacement centers in the country.
The reverse shoulder replacement is less invasive than a hip or knee replacement, requiring just a small incision on the front of the shoulder. The procedure involves minimal postoperative pain and typically one-to-two nights in the hospital. After a period of physical therapy, patients typically are able to return to recreational activities within four-to-six months with no major restrictions. Anatomic shoulder replacements tend to survive 15-to-20 years, and data from Europe, where the reverse procedure has been performed since the early 1990s, suggests that the durability of reverse shoulder replacement is similar.
Dr. Petrigliano says that anyone with a diagnosis of shoulder arthritis who has received insufficient relief from physical therapy or injections is a candidate to seek a surgical consultation. “Most people with shoulder arthritis not only have pain, but can be severely restricted in their activities of daily living because it’s difficult to raise their arm,” he says. “Shortly after recovering from a reverse shoulder replacement, patients can expect complete or near-complete resolution of their pain as well as a restoration of a range of motion that allows them to perform their daily and leisure activities. It’s a huge quality-of-life benefit to be able to return to a more normal lifestyle.”