At the Mayo Clinic
Dr Kenneth Cutbush visited Dr John Sperling at the Mayo Clinic in Rochester, Minnesota, spending a day in the operating theatre observing reverse total shoulder replacement surgery.
Reverse total shoulder replacement, in plain terms
In a normal shoulder, a ball at the top of the upper arm bone sits against a shallow socket on the shoulder blade. The joint is held together and moved by the rotator cuff, a group of four tendons that wrap around the ball. A conventional, or anatomic, shoulder replacement reproduces that arrangement and relies on the rotator cuff to keep working.
When the rotator cuff is torn beyond repair, an anatomic replacement has nothing to control it, and the ball tends to ride upwards instead of turning in the socket. A reverse replacement solves that by turning the geometry around. The ball is fixed to the shoulder blade and the socket is placed on the upper arm bone, which changes the mechanics so that the deltoid, the large muscle over the outside of the shoulder, can lift the arm without the rotator cuff. It is used for arthritis in a shoulder with an irreparable cuff tear, for some complex fractures around the shoulder, and sometimes when an earlier replacement has failed. Individual results vary.
Learning technique in someone else's theatre
Reverse replacement is a technically demanding operation in which the position of the components, by a few millimetres and a few degrees, changes how the shoulder then works. Those judgements are not easily written down. Spending a day watching a full list shows the approach applied across several different patients, including the ones whose anatomy does not match the diagram, and it allows questions to be asked in the moment rather than afterwards.
These visits are also how international teaching networks form. Surgeons who have operated alongside each other go on to teach on the same courses, compare results, and consult each other on difficult cases.
Related information
- Prof Sperling later joined the faculty of the Advanced Shoulder Symposium in Sydney, covered in our post on the Advanced Shoulder Symposium.
- The reverse total shoulder replacement page.
- The rotator cuff tear page.
- The shoulder arthritis page.