Reverse Shoulder Reverse Shoulder ReplacementReplacement

Thomas J Kovack DOThomas J Kovack DO

Reverse Shoulder Reverse Shoulder ReplacementReplacement

Normal Joint Anatomy Normal Joint Anatomy

Anatomy – Rotator CuffAnatomy – Rotator Cuff

4 Muscles4 Muscles 1 in front1 in front 1 on top1 on top 2 behind2 behind

Muscle Action of the Muscle Action of the ShoulderShoulder DeltoidDeltoid

Wants to pull arm upWants to pull arm up Requires stable jointRequires stable joint

Rotator CuffRotator Cuff Pulls Humeral Head Pulls Humeral Head

into Glenoidinto Glenoid Establishes stability of Establishes stability of

the joint to allow the joint to allow deltoid to elevate the deltoid to elevate the armarm

Normal Normal ShoulderShoulder

Shoulder Shoulder without without

Rotator CuffRotator Cuff

Rotator Cuff Stabilizes JointRotator Cuff Stabilizes Joint Smooth MotionSmooth Motion

Unstable JointUnstable Joint Upward migration of humeral head Upward migration of humeral head

prevents normal motionprevents normal motion

Development of ArthritisDevelopment of Arthritis InstabilityInstability Breakdown Breakdown

of cartilageof cartilage Loss of Loss of

smooth smooth surfacessurfaces

Loss of joint Loss of joint spacespace

Bone erosionBone erosion Bone SpursBone Spurs

SymptomsSymptoms PainPain

Progress over timeProgress over time Worse with activity Worse with activity Interferes with sleep Interferes with sleep

InstabilityInstability Loss of MotionLoss of Motion Atrophy (wasting) of muscles Atrophy (wasting) of muscles SwellingSwelling Crepitus (clicking, popping or crunching Crepitus (clicking, popping or crunching

sound) sound) Tenderness to touchTenderness to touch

Treatment – non-Treatment – non-operativeoperative Anti-Inflamatories Anti-Inflamatories

(NSAIDs)(NSAIDs)

Cortisone Injection Cortisone Injection Physical TherapyPhysical Therapy Activity ModificationsActivity Modifications

When to consider When to consider surgerysurgery Quality of Life DecisionQuality of Life Decision

Interferes with activitiesInterferes with activities Loss of independenceLoss of independence

GroomingGrooming BathingBathing DressingDressing

Interferes with sleepInterferes with sleep Interferes with workInterferes with work

OperationOperation

IncisionIncision from collar bond from collar bond

down the armdown the arm Release Release

Subscapularis Subscapularis TendonTendon Rotator Cuff TendonRotator Cuff Tendon Allows visibility of Allows visibility of

jointjoint MUST BE REPAIRED MUST BE REPAIRED

AND PROTECTEDAND PROTECTED

OperationOperation

Remove arthritis Remove arthritis from humeral headfrom humeral head Replace with metal Replace with metal

stem and plastic stem and plastic socketsocket

Remove arthritis Remove arthritis from glenoidfrom glenoid Replace with metal Replace with metal

glenosphereglenosphere

OperationOperation

Subscapularis Subscapularis Tendon RepairedTendon Repaired Takes 3 months to Takes 3 months to

healheal Must be protectedMust be protected Shoulder Shoulder

Immobilizer for 6 Immobilizer for 6 weeksweeks

Post-operative Post-operative RehabilitationRehabilitation Phase 1 (0-6 Phase 1 (0-6

weeks)weeks) Shoulder Shoulder

ImmobilizerImmobilizer Pendulum Pendulum

exercises onlyexercises only Pool therapyPool therapy

Post-operative Post-operative RehabilitationRehabilitation Phase 2 (6-12 Phase 2 (6-12

weeks)weeks) StretchingStretching Sling when out of Sling when out of

househouse Begin to use armBegin to use arm

Golf put, no swingGolf put, no swing No liftingNo lifting

Post-operative Post-operative RehabilitationRehabilitation Phase 3 (3 months+)Phase 3 (3 months+)

StrengtheningStrengthening Activities as tolerated at 6 monthsActivities as tolerated at 6 months

AppointmentsAppointments

Pre-operative VisitPre-operative Visit Post-operative Visit (1 week)Post-operative Visit (1 week) 11stst Follow-up (6 weeks) Follow-up (6 weeks) 22ndnd Follow-up (12 weeks) Follow-up (12 weeks) 33rdrd Follow-up (6 months) Follow-up (6 months) 44thth Follow-up (1 year) Follow-up (1 year) Annual VisitsAnnual Visits

What to expectWhat to expect

Pain Relief Pain Relief Improvement in functionImprovement in function

Increased range of motionIncreased range of motion Increased ability to perform activitiesIncreased ability to perform activities Improved quality of lifeImproved quality of life

Return of IndependenceReturn of Independence

60 Patients followed for 33 60 Patients followed for 33 monthsmonths

Average age 71Average age 71 Increased Range of Motion

Forward flexion from 55.0° to 105.1° Abduction from 41.4° to 101.8°

95% satisfaction rating 68% good to excellent result 27% satisfied were satisfied 5% dissatisfied (mechanical failures)

ComplicationsComplications Infection Infection Wound problems Wound problems Excessive blood loss Excessive blood loss Injury to nerves and blood vessels Injury to nerves and blood vessels Failure of Subscapularis RepairFailure of Subscapularis Repair Mechanical Failure of DeviceMechanical Failure of Device Fracture Fracture Weakness Weakness Stiffness Stiffness Subluxation or dislocation of the prosthesisSubluxation or dislocation of the prosthesis Requirement for additional surgery Requirement for additional surgery Anesthetic risks Anesthetic risks