Anatomic And Reverse Total Shoulder Replacement In New Jersey

More than 800,000 Americans live with an artificial shoulder joint and tens of thousands more undergo total shoulder replacement surgery every year. When shoulder issues are severe or have been unresponsive to conservative treatment options, a total shoulder replacement can improve range of motion and strength, restore function, and lead to an overall higher quality of life.

Anatomic total shoulder replacement surgery (TSR) replaces the ball and socket of the shoulder with prosthetic components that mimic the joint’s natural anatomy. In contrast, a reverse total shoulder arthroplasty procedure (RSA) switches, or reverses, the placement of the prosthetic ball and socket. TSR remains a common procedure, but since the RSA procedure was approved by the FDA in 2003, it has become an increasingly popular treatment option for patients with specific types of shoulder conditions and injuries. These include large rotator cuff tears, a type of degenerative arthritis known as rotator cuff arthropathy, complex shoulder fractures, and more.

At Modern Orthopaedics of New Jersey, our world-class team of doctors specializes in the accurate diagnosis and innovative treatment of shoulder joint damage stemming from a wide variety of different causes. Depending on the specifics of your case, you may be a candidate for an anatomical or reverse total shoulder replacement procedure. To learn more about our state-of-the-art approach to shoulder surgery and receive an individualized treatment plan, schedule an initial consultation with our team today!

Understanding Total Shoulder Replacement Options

The two total shoulder replacement surgery options are: Anatomic total shoulder arthroplasty (TSR) and reverse total shoulder arthroplasty (RSA). In order to better understand the differences between these procedures, it is helpful to review the shoulder joint’s basic anatomy:

The human shoulder joint, the most flexible joint in the human body, brings together the upper arm bone (humerus) and the shoulder blade (scapula). It is known as a ball and socket joint because the rounded end of the humerus bone (humeral head) fits inside a shallow socket in the scapula, known as the glenoid cavity. In a healthy shoulder, cartilage, tendons, and ligaments surround the shoulder joint, providing support and helping it move smoothly.

Shoulder replacement surgery can restore function and stability to the shoulder joint when some or all of its components have been severely damaged. During a traditional shoulder replacement procedure (anatomic total shoulder arthroplasty), the humeral head is replaced with a smooth metal ball, sometimes attached to a stem, and the glenoid cavity is replaced with a plastic socket. During a reverse shoulder replacement procedure (reverse total shoulder arthroplasty), the position of the two prosthetic components is switched, effectively reversing the joint’s natural anatomy.

Anatomic Vs. Reverse Prosthesis Design

The differences in prosthetic design between an anatomic and reverse total shoulder replacement are as follows:

• Anatomic Total Shoulder Arthroplasty
• A plastic socket is fitted into the shoulder (glenoid cavity).
• A metal ball is attached to the top of the upper arm bone (humeral head).
• Reverse Total Shoulder Arthroplasty
• A plastic socket is affixed to the top of the upper arm bone (humeral head).
• A metal ball is affixed to the shoulder socket (glenoid cavity).

A standard TSR procedure has the highest likelihood of success when the muscles, ligaments, and tendons surrounding the shoulder joint are fully intact. In cases where extensive damage has occurred to the rotator cuff or other nearby structures, TSR surgery may not effectively restore shoulder function and an RSA procedure may be indicated. This is because the reversal of the ball and socket components of the shoulder joint during RSA surgery allows other muscles, specifically the deltoid muscle, to engage in the work typically done by the rotator cuff. Patients who undergo an RSA procedure after severe rotator cuff damage typically experience significant improvements in shoulder strength, stability, and overhead function.

What Makes You A Candidate For Anatomic or Reverse Shoulder Replacement

Shoulder replacement surgery is not typically the first line of treatment for shoulder conditions and injuries, but may be recommended in cases that have been unresponsive to more conservative treatment options or where damage to the shoulder joint is causing severe pain and/or loss of function.

At Modern Orthopaedics of New Jersey, we may consider you a candidate for anatomic shoulder replacement surgery if:

• Shoulder pain and discomfort are limiting your ability to perform daily activities.
• Shoulder pain is accompanied by weakness, stiffness, and/or loss of range of motion.
• Conservative treatment options have been ineffective in resolving shoulder pain and discomfort.

We may consider you a candidate for reverse total shoulder replacement surgery if:

• You have a completely torn rotator cuff that cannot be repaired.
• You have rotator cuff arthropathy.
• You have a complex fracture of the shoulder joint.
• Previous shoulder surgeries have been unsuccessful in relieving pain and restoring the function of the shoulder joint.

Conditions Treated By Anatomic Replacement

Anatomic shoulder replacement surgery can be used to treat a wide range of shoulder conditions and injuries, rheumatoid arthritis and osteoarthritis of the shoulder joint being two of the most common. Our award-winning team at Modern Orthopaedics of New Jersey is most likely to recommend a TSR procedure in cases where damage to the shoulder is extensive and debilitating but the rotator cuff muscles and other structures surrounding the shoulder joint remain intact.

Scenarios Requiring Reverse Replacement

Reverse shoulder replacement surgery is often recommended in cases where severe damage has occurred to the rotator cuff or other muscles/structures surrounding the shoulder joint. Consult with one of our leading doctors to explore the underlying causes of your shoulder pain and learn whether or not an RSA procedure could be the right treatment option based on your specific circumstances and goals.

Surgical Procedures And Techniques

Anatomic and reverse total shoulder replacement procedures both take approximately two hours to complete. At Modern Orthopaedics of New Jersey, we use advanced 3D-printed patient-specific guides to ensure exceptionally precise placement of prosthetic hardware.

Anatomic and Reverse Total Shoulder Replacement Process

An incision is made in the front of the shoulder so that the damaged sections of the shoulder joint can be removed and replaced with metal/plastic prosthetic implants.

Recovery And Rehabilitation

Post-Operative Care For Both Procedures

The affected arm is placed in a sling following a TSR or RSA procedure. A few days of rest and icing will be required, and the Modern Orthopaedics of New Jersey team will tailor a pain management plan to the needs of each patient.

Rehabilitation Protocols And Expected Outcomes

After the initial recovery period of a few days, most patients are able to independently perform daily routines such as eating, dressing, and grooming. Physical therapy is a vital element of rehabilitation after total shoulder replacement, and it is essential to consistently do the stretches and exercises provided by your physical therapist and/or medical team.

It is not uncommon for mobility and function to continue to improve for up to 12-18 months after TSR or RSA.  Most patients can return to desk work within 4-6 weeks after total shoulder replacement, but returning to a more physically demanding job may take longer. Your doctor will monitor your recovery progress closely.  

For many patients, a total shoulder replacement offers a long-term solution that can resolve shoulder pain, weakness, and instability for a decade or more. To learn more about the expected outcomes of anatomic or reverse total shoulder replacement arthroplasty based on your particular situation, contact Modern Orthopaedics of New Jersey to book an initial consultation today. We look forward to working with you!

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