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The shoulder joint is extremely mobile, the unhindered movement of which depends on the harmonious synergy of bones, tendons and muscles. A very basic role in the smooth movement of the shoulder is played by the tendons that form the so-called rotator cuff of the shoulder.

However, if these tendons have suffered irreparable damage, the mechanism of support and elevation of the upper limb is significantly disrupted, resulting in the appearance of functional limitations and pain. If this condition is complemented by wear and degeneration of the articular surfaces, then the issue becomes even more complicated. However, here, in advanced cases, reverse total shoulder arthroplasty comes to the rescue. This procedure is designed to address these challenges, particularly when traditional total shoulder arthroplasty is not sufficient.

What is reverse total shoulder arthroplasty?

Reverse total shoulder arthroplasty is a specialized surgical technique designed to repair severe damage to the shoulder joint, particularly when the rotator cuff is inadequate or has suffered irreversible tears. In contrast to the anatomical approach, in which the implants are placed according to the normal structure of the shoulder, in reverse total shoulder arthroplasty, the location of their placement is reversed.

In traditional total shoulder arthroplasty, the humeral head is replaced with a metal implant and the glenoid cavity with a polyethylene implant, in order to reproduce the normal anatomy and biomechanics of the glenohumeral joint. However, in the reverse version, the philosophy of the replacement is completely changed: a “ball” is placed in the glenoid cavity and a concave surface (socket) is placed at the upper end of the humerus. This reversal aims to enhance the stability of the joint and allows effective activation of the deltoid muscle to elevate the upper limb, even when the rotator cuff muscles are unable to fulfill their role. This technique was developed in the 1980s and is currently the most common shoulder arthroplasty technique, especially in patients over 70 years of age.

When is this technique chosen?

This specific method is recommended in cases where the patient suffers from:

• Degenerative arthritis of the shoulder with associated rotator cuff tears horseshoe

• Chronic, irreparable rotator cuff tears

• Serious intra-articular fractures in the elderly, where anatomical reconstruction is impossible

• Failed previous arthroplasties (revisions)

• Infections or loosening of previous prostheses

Function and biomechanical advantages

By reversing the articular surfaces, the center of rotation of the joint is shifted medially and downwards. This allows the deltoid muscle to “lift the weight” of the movement, providing the ability to elevate and abduct the upper limb, without the need for rotator cuff function.

The main advantages of this technique include:

• Significant relief from chronic pain

• Improvement of shoulder mobility

• Possibility of restoration even in complex cases

Surgical procedure

The operation is performed under general anesthesia and lasts approximately 60 to 90 minutes. Depending on the patient’s general condition and the complexity of the case, the operation time may vary. Regional anesthesia is usually used for better postoperative pain control.

Implant materials

The prostheses used are made of high-strength materials such as titanium, cobalt-chromium, polyethylene and ceramics. Ceramics are considered among the most advanced materials with excellent durability and durability.

Postoperative hospitalization and rehabilitation

The patient usually stays in the hospital for 1 day. From the third postoperative day, he is usually able to take care of himself, while within the first week he can progressively return to simple daily activities.

Long-term results and success

The long-term success of reverse arthroplasty is impressive, with rates reaching 90-95% over a fifteen-year period. Annual follow-up x-rays are necessary to monitor the prosthesis. 

In general, reverse totalshoulder arthroplasty is the appropriate choice for patients who present not only extensive damage to the articular surfaces of the shoulder, but also to the tendons and muscles of the rotator cuff. With high success rates, immediate pain relief and impressive restoration of joint functionality, it is a highly beneficial technique for treating complex shoulder pathologies, especially when conventional methods are not particularly promising.