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My father is going to have a special kind of shoulder replacement called "reverse." He is 72-years-old, a former Marine sargeant and ardent baseball player. This is going to set him back quite a bit. How well do these new kind of reverse replacements hold up? He says he's still got a good 30-years left in him and thinks he will outlive what he calls "my fake shoulder."

Shoulder joint replacement surgery (also called shoulder arthroplasty) can ease pain from shoulder arthritis. Most people experience improved shoulder function after this surgery. But, some people like your father are not candidates for joint replacement of the shoulder because they lack the muscle function necessary to stabilize the joint. A different type of shoulder replacement, called reverse shoulder replacement or reverse shoulder arthroplasty (RSA), is used instead. The reverse shoulder arthroplasty (RSA) is used for several different types of problems. The most common reason for choosing the RSA is a weak or deficient rotator cuff. The rotator cuff is a group of four muscles that wrap around the shoulder to hold it in the socket. They also help move the shoulder. RSA is an option when the rotator cuff is no longer strong enough or functioning well enough to hold the shoulder in the socket. The RSA provides pain relief as well as a stable functioning shoulder. According to a recent study from the Florida Orthopaedic Institute and Foundation for Orthopaedic Research and Education in Tampa, Florida the average length of time these implants last is 73.5 months (a little more than six years). In their study, almost all implants were still in place and working well at the end of six years. Five patients had to have revision surgery because some part of the implant came loose or the bone graft used was resorbed (broken down and absorbed) by the body. There was no sign of bone loss around the implant in any of the patients. A new development not seen in the previous study was the presence of scapular notching. This change was seen in about nine per cent of the group. Scapular notching describes a problem that occurs when the medial (inside) edge of the socket (now located at the top of the humerus) bumps up against the lateral (outside) edge of the scapula (shoulder blade) where the new round ball (glenosphere) is located. Loss of shoulder motion occurs from this type of impingement. The surgeons concluded from this mid-term study of their RSA patients that the shoulders remained stable and the implants durable. The new development of scapular notching is concerning and all patients will continue to be followed for the next five years (total of 10 years since the first RSA surgery). Because reverse shoulder arthroplasty is a fairly new procedure, long-term results aren't available yet. Your father will likely be someone whose response over time will be of interest to surgeons. Early to mid-term results are very encouraging at this point. Patient motion is restored, pain is reduced, and function improved. At least in the short to mid-term period of time, patients report this surgery was well worth it!

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