What happens during reverse shoulder replacement surgery?

I’d like to tell you about a reverse ball and socket implant. Typically, we do this implant for someone who has a massive rotator cuff tear as well as arthritis. So I’m going to go over some x-rays (gestures toward the computer).

The shoulder is made up of a ball (gestures in a circular motion on the x-ray image of a shoulder joint), as well as a socket (gestures in a curved motion to the right of the ball area on x-ray). When someone has a massive rotator cuff tear as well as arthritis we start seeing that the ball rides high on this socket here (pointing to the x-ray). So normally, the ball should be down here, but you can see in this picture that the ball has ridden up and is riding high. And so what we get is cartilage loss at the top of the ball as well as the socket, and we also get cartilage loss where it articulates with the acromion. That’s the bone on the top of your shoulder. So what happens in a normal should is the ball rides and is contained within the socket normally, because you have normal tendons that hold it there. But in a massive cuff tear what we start to see is that the ball starts to ride high on the socket and we get edge loading on that socket which creates arthritis, and then you get that new articulation with that bone on the top of your shoulder.

So for the implant, what we do is we put a ball on the socket and a socket on the ball. What that allows us to do is to bring this ball all the way back down so that it’s in its normal position. It also allows the deltoid to start moving the shoulder. So this is the big muscle on the outside part of the shoulder you can feel so we don’t have to rely on the internal tendons anymore in the shoulder. So for the implant, this is what it looks like. So this is the socket that we put on the ball, and this is the ball we put in the socket. We bring that back down and you have a new articulation in your shoulder. This is what it looks like at the time of surgery in the bone. So you can see here that we’ve got a new ball in the socket and the socket is now in that previous ball. That creates the new joint and you don’t have pain anymore.