Clinical Briefing:
Reverse Shoulder Replacement Surgery
July/August 2008
Surgeons at the Shoulder
and Elbow Service at Penn are performing
reverse shoulder replacement surgery to treat intractable shoulder pain and
dysfunction. An innovative procedure, reverse shoulder replacement surgery
employs a prosthesis (Figure 1) to reverse the anatomy of the normal shoulder.
This configuration avoids the displacement, instability and limitation of
motion that frequently occurs when conventional arthroplasty is used to treat
certain types of shoulder problems.
The
Reverse Shoulder System attaches a
component representing the ball of the humerus
directly to the scapula and places a socket
at
the humeral epiphysis to “reverse” the
normal
shoulder anatomy and restore the normal
shoulder center of rotation in patients with
large
rotator cuff deficiencies and shoulder arthritis. |
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Reverse shoulder surgery is often used for
patients with chronic, long-standing rotator cuff tears and
arthritis, or to treat
the sequelae of shoulder fractures previously treated with
replacement surgery. Patients who receive the prosthesis
typically report significant reductions in pain within three
months of surgery, as well as improved function, flexibility
and range of movement.
Case Study
Mr. M, a 66-year-old man with a year-long history of shoulder
pain was referred to the Penn Shoulder and Elbow Service
for evaluation of progressive weakness, chronic pain and
limitation of movement in his right shoulder. At Penn,
an X-ray and subsequent MRI of the shoulder demonstrated
deterioration of the glenohumeral joint with superior migration
of the humeral head (Figure 2) and a retracted irreparable
rotator cuff tear (Figure 3). After a discussion of his
options, Mr. M chose to have reverse shoulder surgery.
Two
views of the glenohumeral joint demonstrating
superior migration of the humeral head subsequent
to a retracted rotator cuff tear. |
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Prior
to surgery, additional anteroposterior and lateral radiographs
were taken to determine the optimum implant position of
both the glenosphere and the humeral component. The glenohumeral
joint was opened and dissected to allow removal of abnormal
tissue resulting from arthritis and chronic rotator cuff
injury. After the deformed humeral head was removed, the
humeral medullary canal was prepared, and the stem support
for the socket inserted and press-fit into the humerus
for subsequent bony ingrowth.
Next, the glenoid was prepared
for placement of a baseplate into which bone grows, and
the glenosphere was locked into this. Trials were then
performed to ensure proper range of motion, soft tissue
balance and implant stability, after which the final polyethylene
socket was attached to the humerus. The repairable portion
of the rotator cuff was reattached and the skin closed
in layers, concluding the surgery.
Mr. M's post-operative
recovery was uneventful. At his two-week follow-up visit,
he reported a substantial reduction in pain and discomfort.
Now more than three months out from his surgery, he has
no pain and uses his arm for functions of daily living.
He is currently preparing for replacement of his left shoulder.
Our Team of Faculty
The Penn Shoulder and Elbow Service is comprised of a team of
orthopaedic surgeons, rehabilitation and family practice physicians, nurses
and physical therapists dedicated to patient care. To enhance the mobility,
independence, and quality of life of orthopaedic patients, Penn Shoulder and
Elbow Service physicians create and use the latest advances in shoulder and
elbow diagnosis, treatment and rehabilitation.
Department of Orthopaedic Surgery
David L. Glaser, MD
Chief, Shoulder and Elbow Service
Director, Shoulder and Elbow Fellowship Program
Assistant Professor of Orthopaedic Surgery
A
graduate of Cornell University Medical College,
Dr. Glaser completed his
residency and fellowship training at the Hospital
of the University of
Pennsylvania. Dr. Glaser's specialties
encompass the treatment of shoulder
and elbow disorders, including complex revision
surgeries, fracture repairs,
sports injuries and shoulder replacement surgery.
G.
Russell Huffman, MD, MPH
Assistant Professor of Orthopaedic Surgery
Dr.
Huffman attended Duke University School of
Medicine and completed his
internship and residency at the University
of California at San Francisco. He
subsequently completed a shoulder and elbow
fellowship at the University of
Southern California, and pursued further subspecialty
training in elbow
surgery at the Mayo Clinic. Dr. Huffman specializes
in the arthroscopic
treatment of athletic shoulder and elbow disorders,
as well as joint
replacement and fracture repair surgery of
the shoulder and elbow.
Access
Patient appointments are available
at:
Penn Orthopaedic Institute
Penn Presbyterian Medical Center
1 Cupp Pavilion
38th and Market Streets
Philadelphia, PA 19104
Penn Orthopaedic Institute
Penn Medicine at Radnor
250 King of Prussia Road
Radnor, PA 19087
Penn
Sports Medicine Center
235 S. 33rd Street, 1st Floor
Weightman Hall
Philadelphia, PA 19104
To refer a patient and/or consult with
a doctor call 800-789-PENN (7366) or you can also refer
a patient online.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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