Reverse Shoulder Replacement (Delta joint replacement) for arthritis: Surgery with a reverse prosthesis can lessen shoulder pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability.

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Summary

Overview

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Rotator cuff tear arthropathy (arthritis with a large cuff defect) is a devastating condition that seriously compromises the comfort and function of the shoulder. This condition is characterized by the irreparable loss of the rotator cuff tendons and destruction of the normal joint surface of the shoulder. Because these tissues cannot be restored, the shoulder is often weak, painful, and unstable. Using special techniques and a reversed total shoulder design [Figure 1] qualified surgeons can improve the stability of the shoulder and enable the deltoid muscle to power it, even in the absence of a normal rotator cuff.

By contrast, when the rotator cuff is intact, shoulder arthritis is often best treated by a total shoulder replacement. In certain milder cases of rotator cuff tear arthropathy of the shoulder without instability, a special prosthesis with a CTA head may be indicated.

Consultation by the Shoulder and Elbow Service at the University of Washington Medical Center regarding the diagnosis and treatment of shoulder arthritis or other shoulder conditions may be requested by using our online referrals website.

You can also call 206-598-0312 to make an appointment.

In the normal shoulder, the rotator cuff muscles, including the supraspinatus, help balance the ball of the arm bone (humeral head) in the socket against the upward pull of the deltoid muscle. [Figure 2].

In rotator cuff tear arthropathy, the rotator cuff tendons that normally are interposed between the humeral head and the overlying coracoacromial arch become progressively thinned until the humeral head moves upwards and rubs against the bone of the arch. [Figure 3].

In stage 1A of rotator cuff tear arthropathy the humeral head remains centered in the socket (glenoid) in spite of a large rotator cuff tear [Figure 4]. In stage 1B of rotator cuff tear arthropathy the humeral head migrates medially into the socket (glenoid) [Figure 5]. In stage 2A of rotator cuff tear arthropathy the humeral head migrates upwards, but is stabilized by the overlying coracoacromial arch in spite of the lack of rotator cuff. [Figures 6 and 7]. In stage 2B of rotator cuff tear arthropathy the humeral head is unstable, migrating upwards and forwards because it is no longer held in position by the coracoacromial arch. This condition often arises after previous procedures such as an acromioplasty when performed in the presence of a large cuff tear. [Figure 8] In this situation, the arm often cannot be raised from the side, even though the deltoid muscle is working; this is called ‘pseudoparalysis’.

After performing a clinical exam, a shoulder surgeon experienced with rotator cuff tear arthropathy can suggest what type of surgery is most likely to be helpful to the individual with the condition. Individuals are most likely to benefit from this surgery if they are well motivated and in good health.

Shoulders demonstrating changes of Stages 1A, 1B, and 2A with substantial loss of comfort and function may be considered for shoulder arthroplasty using a cuff tear arthropathy (CTA) prosthesis.

Shoulders with stage 2B cuff tear arthropathy and with substantial loss of comfort and function are considered for the reversed total shoulder (reverse Delta) prosthesis because other options may not provide sufficient stability for the humeral head (ball of the shoulder joint). The reversed (reverse Delta) total shoulder prosthesis is designed with a socket where the ball (head of the humerus) is normally located and a ball where the socket (glenoid) is usually located. This configuration adds stability so that the deltoid muscle can power the shoulder.

The goal of reverse total shoulder replacement is to restore some function to the joint destroyed as a result of cuff tear arthropathy by providing stability and a fulcrum against which the deltoid muscle can help elevate the shoulder to a level where some basic shoulder functions can be performed.

Reverse total shoulder replacement is a highly technical procedure and is best performed by a surgical team who has experience with this surgery. Such a team can maximize the benefit and minimize the risks of surgery.

The two-hour reverse total shoulder replacement is performed under general (or nerve block) anesthesia.

Use of the arm is started several weeks after the procedure. Extensive therapy is not needed with reverse shoulder surgery.

• Articles of interest on Reverse Total Shoulder Arthroplasty (Delta) (PDF) (0.6 MB)
• Articles of interest on The Reverse Delta Prosthesis (PDF) (2.4 MB)

Dr. Matsen discusses a new and innovative shoulder replacement surgery featuring a reverse ball/socket technique that can lessen pain and improve function in shoulders with failed surgery or combined arthritis, rotator cuff tears and instability issues. Click to view streaming video

10 surgery questions for your surgeon before having surgery

Surgery for Reverse Shoulder at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

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