Reverse shoulder replacement has emerged as a groundbreaking intervention for patients previously unsuitable for shoulder replacement due to anatomical irregularities or instability in muscle function. Let’s look at some of the innovations and research updates that have brought reverse shoulder replacement to the forefront of shoulder reconstruction.
What is Reverse Shoulder Replacement?
As the name suggests, reverse shoulder replacement inverts the traditional anatomy of the shoulder joint, placing the ball component on the shoulder blade (scapula) and the socket component on the arm bone (humerus). This innovative approach aimed to compensate for the loss of rotator cuff function by relying on the deltoid muscle for stability and mobility.
Advances in Reverse Shoulder Replacement
Many advances in surgical technique and technology have broadened the scope of the procedure to include treatment of conditions such as complex bone fractures, abnormally healed bone fractures, chronic dislocation, and previous failed implants. These include:
- Lateralization Techniques: Surgeons now employ lateralization techniques,1 which is the repositioning of the shoulder's center of rotation away from its natural anatomical location towards the outside of the joint. This approach aims to improve the biomechanics of the shoulder.
- Modular Design: Modular implants2 allow for greater customization during surgery, enabling surgeons to adapt the implant size and configuration to match each patient's unique anatomy. This versatility enhances implant fit and stability, leading to improved longevity and function.
- Computer-Assisted and Image-Guided Surgery: The integration of computer-assisted and image-guided surgery has been a game-changer. Studies show mixed reality-assisted implantation3 increases the precision of implant placement, potentially improving the longevity of the prosthetic.
- Infection Prevention Strategies: Infection remains a concern with reverse shoulder arthroplasty.4 A systematic approach to prevent infection, including steps before, during, and after surgery, is now a critical part of the surgical protocol.
- Stemless Implants: These implants do not extend into the bone canal, are less invasive and have shown promising results. They are designed to preserve proximal humeral bone stock, which can simplify revision surgery and reduce intraoperative and postoperative periprosthetic fractures.
- 3D Modeling: The use of 3D modeling technology allows surgeons to simulate the surgery virtually, ensuring optimal implant fit and positioning.
Today, reverse shoulder replacement offers hope and relief to countless individuals worldwide suffering from debilitating shoulder conditions. Its evolution underscores the transformative power of medical innovation and serves as a testament to the dedication of surgeons and researchers in advancing the field of musculoskeletal medicine.
AUTHOR: Dr. Anup Shah is a board-certified, fellowship-trained Sports Medicine Orthopedic surgeon specializing in Knee and Shoulder Surgery in Phoenix, Arizona at Banner Health. Dr. Shah uses a patient-centric and an evidence-based approach to help his patients achieve their desired goals.
Reference:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139126/
- https://link.springer.com/chapter/10.1007/978-3-319-33355-7_47
- https://www.aofoundation.org/recon/clinical-library-and-tools/scientific-articles/16_2_preview_mixed-reality-and-reverse-shoulder-arthroplasty
- https://www.aofoundation.org/recon/clinical-library-and-tools/scientific-articles/16_3_preview_preventing-infection-in-reverse-shoulder-arthroplasty
