New Frontiers-Reverse Shoulder Replacement
Daniel R. Yanicko, Jr., M.D. – Saint Joseph Orthopedic Associates
As we all inevitably age, our shoulders begin to wear out and many people develop rotator cuff tendon problems. Impingement syndrome occurs as the tendons of the rotator cuff pinch against the undersurface of the bony arch of the shoulder joint called the acromion. The collar bone or clavicle at its distal end also contributes to this process at the acromioclavicular joint.
Constant friction and wear during shoulder level or overhead activities causes inflammation of the shoulder bursa and tendons; and over time attritional tearing of the tendon. Early treatment, before surgery, for thesepainful full thickness tears of the rotator cuff involves cortisone injection, physical therapy, and anti-inflammatory medications.
Arthroscopic surgery can be performed to shave the undersurface of the acromion and distal clavicle which can relieve this pressure and allow healing of the underlying rotator cuff tendons.
If completely torn, the tendon can many times be repaired back to its bone attachment on the humeral head by arthroscopic or mini-incision open treatment approaches. This surgical treatment plan for rotator cuff disease can relieve pain and will result in improved shoulder function and use almost 80% of the time.
However, there are times when patients develop arthritis from prolonged or recurrent tears of the rotator cuff called rotator cuff tear arthropathy. The humeral head rubs against its bony arch,wearing the cartilage done to raw bone that causes reduced motion and pain.
Shoulder replacement can relieve pain by resurfacing the worn out parts of the joint, but requires an intact rotator cuff tendon group for best long-term results. This procedure resurfaces the ball portion of the shoulder with a new metal ball and stem placed into the humerus, the shoulder’s upper bone. The cup portion of the shoulder joint called the glenoid is resurfaced with a cemented plastic cup. In many cases of rotator cuff disease, though, only the ball portion of the joint called the humeral head can be replaced. This controls pain, but does not allow much in the way of overhead function.
Over the past decade, a newer design of shoulder prosthesiscalled a Reverse Total Shoulder Replacement has been developed to manage many of these patients with shoulders that have irreparably torn rotator cuff tendons. For this procedure, a metal glenosphere ball is now implanted into and over the glenoid, the shoulder joint’s cup portion. The ball portion of the shoulder joint, the humeral head has a stem implanted down the marrow canal fitted with a plastic polyethylene liner that has the shape of a cup. With the correct tension applied to this new shoulder joint, the large shoulder muscle called the deltoid can now be used to raise the arm overhead.
Thus, the term Reverse Shoulder Replacementmeans that resurfacing of the ball and cup joint is done in a reverse fashion from standard Total Shoulder Replacement. Early results have been very promising for goals of pain reduction and return to function for these arthritic shoulders.
Currently, these procedures and other mini-incision total knee and hip surgeries are being performed by Dr. Yanicko at St. Joseph Hospital - Main 1 Saint Joseph Drive Lexington, KY 40504.
For more information on this new joint replacement procedure, contact Dr. Yanicko – St. Joseph Orthopedic Associates at his office: 1868 Plaudit Place, Suite A Lexington, KY 40509-2429. Phone 858-543-0002. Fax: 859-543-0012. E-mail: .