| When shoulders go bad |
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by Brian Wall, MD When hips and knees go bad, patients have known for years that doctors can replace those joints with artificial implants. Not so well known is that surgeons can do the same thing when shoulders go bad—and now there’s a new way to do it. Over 23,000 people in the United States undergo shoulder replacement per year, and the latest developments in the field—especially for people who have exhausted all other means of repair—use what is called a reverse shoulder implant.
The reverse implant is a shoulder replacement prosthesis that reverses the ball and socket structure of a healthy shoulder. When people are born, the upper arm bone, or humerus, ends in a ball, and the shoulder blade, or scapula, forms a socket. However, the prosthesis design has the ball portion attached to the scapula and the socket at the upper end of the humerus. This device was developed over several decades of surgical experience with shoulder implants. In many patients, the kind of damage that made a shoulder replacement necessary also made it impossible for a normal replacement, one that had a standard ball and socket, to work. These patients are usually older people who have significant pain and very little movement in their shoulder or people with severe arthritis who have suffered from fractures or longstanding rotator cuff tears. Cuff tear arthropathy is a devastating condition that seriously compromises the comfort and function of the shoulder. It 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. When a person gets to this stage of shoulder weakness and pain, changes must be made in the actual mechanics, or workings, of the shoulder. Surgeons discovered this after they tried many versions of the standard ball and socket in shoulder replacements, all of which continued to fail because the severely damaged shoulder wouldn’t support their function. In response, the reverse implant was invented. The reverse replacement procedure was born in Europe and has been successfully used there for the past 20 years. In fact, I received my training from one of the developers of the reverse shoulder implant. Each of the components that make up the prosthesis is placed into a patient based upon the size of the patient’s anatomy. The surgery that occurs to properly place this reverse ball and socket implant into the body typically takes one and half to two hours followed by about a two-day stay in the hospital. Use of the arm starts several weeks after the procedure. Since its use in the United States is still fairly recent, there are many studies being conducted to determine the long-term benefits of the implant. Patients who have had little to no range of motion have seen up to 140 degrees in their shoulder movement. This can significantly change a person’s lifestyle, so that they can get back to even the simple things in life like combing their hair. This procedure isn’t for everyone. It’s not recommended for people who have infections, deficiencies in the scapula, or for patients without functioning deltoid muscles. Because it does not restore the ability of the shoulder to perform heavy work or sport, it is also not recommended for younger patients. However, individuals who are well motivated and in good health are likely to benefit from this new procedure. Because extensive therapy is not needed with reverse shoulder surgery, we have been able to measure the important immediate benefit of increased shoulder mobility.
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