Surgical treatments include a variety of procedures: - Total shoulder replacement surgery is a well-established procedure performed to replace the diseased shoulder joint with artificial components. The damaged tissues are removed. The arthritic humeral head is replaced with a metal ball on a stem that fits inside the humerus, the socket is replaced with a plastic component made of high-density polyethylene. - Ream and Run Arthroplasty is a modification of total shoulder replacement procedure. The metal ball replaces the humeral head but the socket is simply shaped, smoothed to fit the ball and left to heal. No plastic component is used. With time, the body grows a cartilage layer on top of the socket.
This procedure is recommended for younger and more active individuals. - Reverse total shoulder or Delta total shoulder replacement - is another modification of total shoulder replacement procedure. The conventional procedure has a metal ball on the humerus - replacing the natural humeral head, and a plastic component on the glenoid. The reverse procedure has the reverse positions of the prostheses: the metal ball is now fixed on the glenoid socket and the plastic cup is fixed in place of the humeral head. This configuration is indicated for people with rotator cuff arthropathy. Why a conventional total shoulder will not work with rotator cuff arthropathy? Rotator cuff arthropathy or cuff tear arthropathy is shoulder arthritis in a setting of rotator cuff tears. Rotator cuff muscles hold the ball and the socket together and prevent the humeral head from moving out of the socket when the deltoid muscle raises the arm. In people with torn rotator cuff, the head of the humerus moves upwards out of the socket resulting in shoulder instability.
Conventional total shoulder preserves the natural configuration of the shoulder joint and therefore will encounter the same problem. Why a reverse total shoulder would work? In reverse total shoulder procedure, the arthritic humeral head is replaced with a plastic cup and the metal ball is fixed onto the glenoid surface. With this configuration, the contraction of the deltoid will move the arm up and compress the socket to the ball at the same time. The ball and the socket will fit more snugly together providing stability.
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