Reverse Total Shoulder Arthroplasty (RTSA)

Reverse Total Shoulder Arthroplasty (RTSA) is a surgical procedure that replaces damaged shoulder joint surfaces by reversing the anatomical placement of the ball and socket components. Unlike a traditional anatomic total shoulder replacement, where the ball (prosthetic head) fits onto the humerus and the socket (glenoid component) is on the scapula, an RTSA places a metal ball onto the scapula (glenoid) and a socket into the humerus. This design relies on the deltoid muscle rather than the patient’s deficient rotator cuff to move the arm and is particularly effective for patients with complex shoulder issues, such as rotator cuff tear arthropathy or severe arthritis.

Biomechanically, Reverse Total Shoulder Arthroplasty (RTSA) is designed in such a way that the center of rotation of the joint is shifted downward and inward.

Therefore, in cases of rotator cuff tendon tears combined with arthritis, it is not necessary for the rotator cuff tendons to be intact in order for shoulder movement to occur. This function is taken over by the deltoid muscle, which serves as the primary muscle responsible for the movement of the joint and the upper limb.

The main advantages of Reverse Total Shoulder Arthroplasty (RTSA) are pain reduction and improved function for patients with severe rotator cuff deficiency, osteoarthritis, or fractures that cannot receive a traditional shoulder replacement.

Reverse total shoulder arthroplasty (RTSA) is typically indicated in patients who have severe shoulder arthritis—meaning the joint surfaces are badly damaged—and at the same time, have a rotator cuff that is no longer functional due to large, irreparable tears.

In these cases, RTSA is the preferred surgical option because it does not depend on the rotator cuff tendons to function. This contrasts with a traditional (anatomical) shoulder replacement, which does require healthy rotator cuff tendons to work effectively.

RTSA is also the treatment of choice for elderly patients who suffer from a complex shoulder fracture, especially when the bone is broken into many fragments (known as a comminuted fracture). In such situations, this surgical procedure is often the most dependable option, as it offers immediate pain relief and allows for improved shoulder mobility.

The most known implants used in reverse total shoulder arthroplasty are typically made from materials such as metal, polyethylene (a type of durable plastic), and ceramic. Among these, ceramic implants represent the latest advancement and are considered the most modern and highest quality option, providing excellent strength, long-term performance, and reliability.

The surgery typically lasts between 1 to 1.5 hours, although the exact time may vary depending on the individual case.

This procedure is performed under general anesthesia, meaning the patient is fully asleep during surgery.

After the surgery, most patients typically stay in the hospital for 1 to 2 days before being discharged to recover at home.

Patients can begin to resume light daily activities within the first week and can expect to return to work and sports within months, though specific timelines vary depending on individual recovery and the demands of the activity.

• Early Stages: Within the first week, patients can start a gradual return to daily routines and may perform basic self-care tasks independently by the third day after surgery.
• Light Chores: Light household chores can often be resumed around three weeks post-surgery.
• Driving: Some patients can typically resume driving once they are off all pain medication and feel comfortable and in control of the vehicle.
• Work: A return to sedentary jobs is possible within 1-2 months, while heavier jobs may require 3-6 months or more.

Physiotherapy is essential for reverse total shoulder arthroplasty (RTSA) recovery, beginning with passive range-of-motion exercises within the first week of surgery. Around three weeks post-op, strengthening exercises are introduced to improve muscle function and shoulder control. The therapy duration can extend for several months, with goals including a return to full function and enhanced dynamic shoulder stability.

RTSA has a very high success rate, with long-term outcomes showing 90% to 95% success over 15 years. Overall, reverse total shoulder arthroplasty is a proven and dependable surgical option for patients with shoulder arthritis and severe rotator cuff damage.

In nowadays, it is the most widely performed shoulder replacement surgery worldwide, offering immediate pain relief and a significant improvement in patients’ quality of life.