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.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, October 28, 2009
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Considering surgery
Types of surgery recommended
Three types of surgery can be helpful in the management of rotator
cuff tear arthropathy (shoulder arthritis associated with massive
rotator cuff defects). The surgical procedures can range from a simple
smoothing of the roughened bone [Figure 15] to a resurfacing of the
humeral head with a smooth prosthesis, such as one with a rotator cuff tear arthropathy
(CTA) head fixed to the shaft of the arm bone (humerus) [Figure 16]. If
the joint is unstable, a reversed prosthesis, such as the reverse Delta
[Figure 17] may be needed.
Who should consider reverse shoulder?
Individuals with rotator cuff tear arthropathy complicated by
shoulder instability should consider joint replacement surgery with a
reversed (reverse Delta) prosthesis if
- the cuff tear arthropathy complicated by instability is a major problem for the individual,
- the individual is sufficiently healthy to undergo the procedure,
- the individual understands and accepts the risks and alternatives,
- there is sufficient bone to permit the surgery,
- the surgeon is experienced in shoulder replacement surgery with a reversed (reverse Delta) prosthesis, and
- no other surgical options are preferable for the individual's shoulder
Shoulder replacement surgery with a reversed (reverse Delta)
prosthesis is most effective when the individual follows a simple
exercise program after surgery and understand the limitations of the
procedure. Thus, the individual motivation and cooperation are
important elements of the partnership.
What happens without surgery?
The rate of progression of rotator cuff tear arthropathy (shoulder
arthritis with a massive rotator cuff defect) is usually slow, thus
surgery is not urgent. Serious instability with associated loss of
function can motivate prompt surgical consideration, however.
Surgical options
Three types of surgery can be helpful in the management of rotator cuff
tear arthropathy (shoulder arthritis associated with massive rotator
cuff defects). The surgical procedures can range from a simple
smoothing of the roughened bone to a resurfacing of the humeral head
with a smooth prosthesis, such as a cuff tear arthropathy
(CTA) head, fixed to the shaft of the arm bone (humerus). If the joint
is unstable, a reversed prosthesis, such as the reverse Delta may be
needed.Effectiveness
In the hands of an experienced surgeon, shoulder arthroplasty with a
reversed (reverse Delta) prosthesis can be helpful in restoring
stability, comfort and function to the shoulder of a well-motivated
individual with cuff tear arthropathy complicated by instability. The
greatest benefits are often the ability to sleep on the affected
shoulder and the ability to perform simple activities of daily living.
As long as the shoulder is cared for properly and subsequent injuries
are avoided, the benefit can last for years.
Urgency
In that rotator cuff tear arthropathy progresses slowly, consideration
of surgery is not urgent. Before surgery is undertaken, the individual
needs to be in optimal health, understand and accept the risks and
alternatives of surgery, and understand the postoperative
rehabilitation program. Only if there is concern about the possibility
of infection in a swollen, warm and red shoulder does urgent surgery
demand consideration. If there is an infection, prosthesis would not be
inserted, but rather the shoulder would require surgical cleaning out
and extensive postoperative antibiotics.Risks
Shoulder replacement surgery for rotator cuff tear arthropathy using a
reversed (reverse Delta) prosthesis carries significant risks that are
important for the individual to consider. The risks of this surgery
include but are not limited to the following: infection (which can be
sufficiently serious to require revision surgery, including removal of
the prosthesis), injury to nerves and blood vessels, fracture,
stiffness or instability of the joint, dislocation, loosening of the
prosthesis, pain, failure of tendon or muscle attachment, and the need
for additional surgeries. Any of these problems may result in major loss
of function to the arm. There are also risks of anesthesia and blood
transfusion (although transfusions are not usually necessary). An
experienced shoulder joint replacement team will use special techniques
to minimize these risks, but cannot totally eliminate them.Managing risk
Some of the risks of shoulder replacement surgery with a reversed
(reverse Delta) prosthesis can be effectively managed if they are
promptly identified and treated. Infections may require a wash out in
the operating room. Sometimes complete removal of the prosthesis is
necessary. Blood vessel or nerve injury may require repair. Fracture
may require surgical fixation. Stiffness or instability may require
exercises or additional surgery. Loosening of the prosthesis may
require surgical revision. If the individual has questions or concerns
about the course after surgery, the surgeon should be informed as soon
as possible.
Surgery for Reverse Shoulder at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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