A reverse total shoulder replacement may be considered in patients suffering severe joint arthritis with irrepairable rotator cuff tears or patients with a deficient rotator cuff suffering superior migration of the humeral head. Another consideration for a reverse total shoulder replacement may include malunion of a proximal humeral fracture or an irrepairable proximal humeral fracture.
The prosthesis used in a reverse total shoulder replacement is similar to what is used in a total shoulder replacement, however the prosthesis is reversed. The metal ball portion of the prosthesis replaces the glenoid and the socket is attached to a stem that is placed into the humeral bone.
If there is a severe weakness of external rotation of the arm or complete irrepairable tears of the rotator cuff, a latissimus dorsi transfer is used. This involves transferring the latissimus dorsi and teres major to act as external rotators, rather than internal rotators of the humerus. This provides stronger support and stability for the new prosthesis and a greater active range of motion.
At day one postoperatively an xray will be performed to check the position of the prosthesis and physiotherapy will commence. Patients will be in a sling for 4 weeks and will have a review with Dr Cutbush at that time.
I use the following prostheses in most instances:
Wright, Tornier Ascend Flex
Zimmer Biomet Comprehensive
Depuy Global AP
Depuy Global Extend
These prostheses have established track records in the Australian Shoulder Registry. With excellent performance in terms of longevity.