Reverse Shoulder Arthroplasty

The shoulder is a complex joint that plays a crucial role in various upper limb activities. Various traumatic and degenerative diseases of the arm and irreparable arthropathies of the rotator cuff can lead to intense, excruciating pain and loss of joint functionality.

Although traditional surgeries to replace worn joint surfaces of the shoulder, such as total shoulder arthroplasty, are effective in treating a number of pathologies, in the aforementioned cases it may not provide satisfactory results.

For patients with these conditions, conventional shoulder arthroplasty can lead to pain and restriction of movement, so reverse shoulder arthroplasty is a better option.

The innovation of reverse total arthroplasty has revolutionized the treatment of complex shoulder pathologies. More generally, arthroplasty involves the replacement of worn joint surfaces with special implants, which include an artificial head and a hollow section.

These implants mimic the normal anatomy of the shoulder, as the hollow part of the prosthesis is placed at the point of the damaged shoulder blade, while the artificial head is normally placed at the upper end of the arm.

However, in reverse total arthroplasty, the placement of the implants is reversed, resulting in the artificial head being placed in the worn scapula and the hollow part of the prosthesis at the upper end of the arm.

One of the main indications for reverse shoulder arthroplasty is rotator cuff arthrosis. This condition occurs when a full-thickness, irreparable rupture of the rotator cuff leads to progressive arthritis of the glinobrachial joint. The damaged muscles of the rotator cuff cannot maintain the stability of the joint, resulting in pain and significantly limited range of motion.

Reverse shoulder arthroplasty can relieve pain and restore joint functionality, relying on the deltoid muscle to provide stability. This procedure is also indicated for crushing, complex fractures of the proximal humerus that cannot be adequately treated with conservative management or other surgical techniques. By replacing the head of the humerus and reshaping the glenoid, reverse shoulder arthroplasty can provide a significant improvement in symptoms.

In cases where traditional total shoulder arthroplasty has failed to relieve pain or restore joint functionality due to factors such as extensive rotator cuff damage, reverse shoulder arthroplasty may be recommended as a revision procedure.

This operation can restore joint stability and improve patients’ symptoms. At the same time, patients with severe or post-traumatic glinobrachial arthritis and concomitant inability of the rotator cuff to perform its function, may benefit from reverse arthroplasty. Indications for this operation also include the manifestation of pseudoparalysis of the shoulder due to irreparable extensive rupture of the rotator cuff.

Also, reverse total arthroplasty is a valuable choice in case of chronic non-realigned shoulder dislocation or in patients suffering from inflammatory joint diseases such as rheumatoid arthritis. In these cases, reverse shoulder arthroplasty is the only reliable solution, as it provides immediate pain relief and excellent mobility of the shoulder.

Before undergoing reverse shoulder arthroplasty, patients undergo a thorough preoperative evaluation. This includes taking a detailed medical history, clinical examination, imaging tests (X-rays, MRI) and evaluation of functional limitations. In addition, patients are evaluated for any contraindications to surgery, such as active infection, neurological deficits, or severe osteopenia.

The operation is performed under general anesthesia and lasts, depending on the case, from one to, one and a half hours. During reverse shoulder arthroplasty, the damaged cartilage and bone is excised, followed by the placement of special implants in order to restore the functionality of the joint.

After the operation, patients usually spend 1 night in the hospital. During the first few days after surgery, patients may feel pain, swelling, and discomfort. Pain management with painkillers and early mobilization with the help of a physiotherapist, is crucial.

Immediately after the operation, patients begin a specially designed physiotherapy program to improve their range of motion, while 3 weeks after the surgery, muscle strengthening exercises begin to be added to the program.

By reversing the anatomy of the shoulder joint, this operation provides patients with improved pain relief and improved functional results.  If performed according to the appropriate indications, the operation has excellent success rates.

The Orthopedic Surgeon of the Upper Extremity, Dr. Panagiotis Pantos, performs reverse shoulder arthroplasty in order to restore the underlying condition and restore the functionality of the joint.