Traditionally, total shoulder arthroplasty (TSA) is shoulder replacement surgery for patients with
end – stage arthritis and those with severe traumatic shoulder damage with an intact rotator cuff.
A well-functioning rotator cuff uses cuff muscles to power arm range of motion.
The goal of shoulder replacement is to restore function and relieve pain. Joint replacement is the last, best option to restore function and quality of life. However, TSA often fails in patients with cuff tears and end-stage osteoarthritis due to biomechanical challenges.
A total shoulder replacement requires the patient to have a well-functioning rotator cuff. Patients with significant rotator cuff dysfunction with and without osteoarthritis, rheumatoid arthritis, complex fractures of the upper arm and shoulder blade, and patients with rotator cuff arthropathy are not good candidates for a total shoulder replacement.
Reverse total shoulder arthroplasty (RTSA) is a better option for these patients to find pain relief and improved function for a better quality of life. More than 90% of patients who undergo reverse total shoulder arthroplasty report significant pain relief and function restoration.
The RTSA procedure replaces the ball and socket of the joint but is reserved for patients with certain complex shoulder conditions who do not have an intact rotator cuff; and have end-stage arthritis in the joint.
Who is a good candidate for an RTSA procedure?
- patients with massive irreparable cuff tears and no arthritis
- patients with massive irreparable cuff tears and end-stage arthritis
- patients with socket bone loss from primary osteoarthritis or rheumatoid arthritis
- patients with a previous failed shoulder replacement
- patients with severe shoulder pain and pseudoparalysis – the inability to raise the arm away from the side or over head
- patients with chronic shoulder dislocation
- patients with serious shoulder fractures where the rotator cuff damage is significant including complex shoulder fractures common in the elderly
- patients with tumors in the shoulder joint
- patients with rotator cuff tear arthropathy (RCTA), a chronic condition in which there is severe shoulder arthritis plus a total loss of rotator cuff function due to massive tears or loss of rotator cuff tendons that causes abnormal mechanics which result in instability and destruction of the joint surfaces.
These patients have severe disability, loss of normal mechanics, and are unable to raise the arm away from their side beyond ninety degrees called pseudoparalysis.
The benefits of the RTSA technique
The RTSA technique restructures the shoulder joint to restore the mechanics of shoulder function but without an intact rotator cuff. It offers better stability and improved range of motion for people with cuff tears because it uses the deltoid muscle to help place and power the arm and does not rely on the rotator cuff muscles and tendons. RTSA treats pseudoparalysis. This procedure offers restored shoulder mechanics, improved function and eliminates pain, and studies report that a majority of RTSA patients can return to their choice of sports in about six months.
The rTSA approach is an excellent solution when the damaged shoulder needs new surfaces, but there is not enough healthy tissue to stabilize and move the shoulder. Studies report that rTSA improved function and implants that can last up to 20 years after the surgery. The RTSA has revolutionized the treatment of shoulder conditions that alter natural biomechanics with a low rate of major complications.
Preparing for surgery
Dr. Cooper requires most patients to have a physical to ensure they are healthy and do not have chronic medical conditions that could affect surgery or recovery. Patients will receive complete preoperative instructions and should plan for assistance once they return home.
The procedure
During the procedure Dr. Cooper will remove the damaged bones and place new components to restore function. After surgery you will have a sling and you will receive pain medication and antibiotics to reduce your risk for infection. Patients will often go home the same day as surgery. Rehabilitation will involve a plan of physical therapy for 3-4 months to help you regain range of motion, flexibility and strength.
The rTSA is a complex procedure that is highly technical and requires the most skilled and experienced shoulder surgeons, like Dr. Cooper and his committed highly qualified surgical team.
