Reverse Shoulder Replacement — Restoring Motion and Lives

Imagine shoulder pain so intense you cannot raise your arm to dress, lift a fork or comb your hair.

That is the condition facing patients, mostly elderly, who suffer from a combination of chronic arthritis and unrepairable, chronic rotator cuff tears.

Those patients can benefit from reverse shoulder replacement, a procedure performed at The Orthopaedic Institute at Concord Hospital that typically ends shoulder pain quickly and restores a patient’s shoulder mobility within weeks.

“Many patients who get reverse shoulder replacements can’t lift their arms away from their sides before surgery,” said Dr. Karen Boselli of Concord Orthopaedics, PA (COPA). “They do remarkably well. Almost immediately, that chronic arthritic rotator cuff pain is gone. By the time I take them out of their sling after six weeks, many can already reach their arms above shoulder level.”

In a reverse shoulder replacement, the surgeon reverses the ball and socket that make up the shoulder joint. A normal shoulder joint includes a rounded ball shape atop the arm bone, the humerus, held in place against the socket, or glenoid, by the rotator cuff.

The rotator cuff allows people to lift and reach overhead with their arms. For patients whose torn rotator cuff are beyond repair, surgeons at COPA can reverse the ball and socket — implanting a hemisphere, or rounded end, on the glenoid that snaps into a socket placed atop the humerus. The procedure allows the deltoid muscle to do the work of the torn rotator cuff, relieving pain and restoring mobility.

In addition to addressing chronic rotator cuff or arthritis pain, the procedure can be used to repair complex fractures and for some patients whose arthritis prevents conventional shoulder replacement. Younger patients, those whose work involves heavy lifting, or arthritis patients with healthy rotator cuffs benefit the most from conventional shoulder replacement.

The reverse procedure is considered a last resort, after injections, physical
therapy, medications and modifying activity do not provide relief.

Between 2014 and 2018, Dr. Boselli and her colleagues, Drs. Sean O’Connor and Brendan Higgins, have seen a 160 percent increase in the number of reverse shoulder replacements they perform annually. Dr. Boselli attributes the increase to greater awareness of the procedure and more referrals to her and her colleagues.

The procedures are performed at The Orthopaedic Institute at Concord Hospital. Dr. Boselli said the Hospital’s excellent pre-surgical screening ensures patients are prepared properly and have no other conditions that could cause complications.

Most reverse shoulder replacement patients are hospitalized for 1-2 nights after surgery to be monitored by the Hospital’s specially trained and experienced orthopaedic staff, then discharged to go home.

“I feel confident that any patient is going to have a good experience at The Orthopaedic Institute at Concord Hospital,” Dr. Boselli said. “The nursing staff on the orthopaedic patient care unit is so experienced with doing this. I can feel comfortable scheduling my patients there and knowing everything is going to be fine.”

Lynne Hoyt and Dr. Karen Boselli

Reverse Shoulder Replacement Reversed Pain Immobility

Not long ago, Lynne Hoyt couldn’t raise her right arm to do simple housecleaning. Today, she wears a big smile as she raises her arms above her head signaling a touchdown.

Read Lynne's Story

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