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Shoulder Arthroplasty, Reverse Replacement On the Rise

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, December 15th, 2014

Shoulder Arthroplasty, Reverse Replacement On the Rise

Within the orthopedic world, shoulders are the superstars these days. According to new research, the use of shoulder arthroplasty is on the rise, as is the changeover to treating many complex fractures with reverse replacements instead of hemiarthroplasty. Edward Craig, M.D., M.P.H. is an attending surgeon at Hospital for Special Surgery (HSS). Dr. Craig, who also holds an appointment with Weill Cornell Medical School, tells OTW, “We are seeing an increase in shoulder arthroplasty relative to other large joints because of better technology, more widespread surgeon education, and more predictable and durable implants. In addition, there is a substantial upsurge in reverse shoulder replacement. We have two publications in the pipeline on the national utilization of reverse shoulder and the national utilization of reverses for fracture of the shoulder versus other types of shoulder replacement.”

“When total shoulder replacement was designed it was done so that it looked like and functioned as a normal shoulder, i.e., with a metal ball resting against a plastic socket. However, while this relieves pain, some patients do not have any healthy soft tissue, specifically the rotator cuff, to facilitate movement. The dilemma was then what to do when someone is in pain and needs a new joint but has no healthy soft tissue to either stabilize or move it.”

Dr. Craig, who has co-designed an anatomic shoulder and a reverse prosthesis, says, “The surgical use of reverse prosthesis seems to be increasing both for arthritis and fractures; in the early years of reverse shoulder arthroplasty the reported complication rate was higher than the anatomic shoulder and thus warranted appropriate caution and careful patient selection. But as surgeons have learned more and as implant technology and instrumentation have improved and become more predictable, the complication rates have fallen. The reverse has not had as long of a track record as the anatomic design, however, so we must continue to monitor it closely for several years.”

“The inherent concept in the reverse prosthesis is one in which the positions of the metal ball and plastic socket are ‘reversed’ and the implant itself had more stability and thus could be utilized in the absence of the stabilizing rotator cuff. The other critical piece was that the rotator cuff was not essential for movement…it’s moved by the deltoid muscle, a muscle which functions well in most people even if this is a non functioning rotator cuff.”

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Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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