The articular cartilage that lines our joints is truly incredible.  It is made up of multiple layers and is rigidly fixed to the underlying bone.  Loss of articular cartilage manifests as OSTEOARTHRITIS; the xray hallmarks are joint space narrowing, spurring and cysts in the bone (like a pothole in the street).  Many people I see with normal xrays have been told by another doctor that they have “arthritis” in the shoulder joint, but more often than not, that turns out to be not true.  True osteoarthritis can be treated conservatively with activity modification, injections of steroid medication, occasionally arthroscopic debridement of loose particles and inflamed tissue and perhaps (not yet proven scientifically) stem cells.  The greatest gains in shoulder surgery in the past 15 years have been in shoulder replacement prosthesis design and in surgical technique.

For people who have osteoarthritis and a functional rotator cuff, the surgical treatment is anatomic total shoulder replacement. This technique replaces the ball of the humeral head with a metallic ball, secured by a stem inside the humeral shaft and a high molecular weight polyethylene new surface on the glenoid.

If the rotator cuff is badly diseased or irreparably torn, a reverse total shoulder replacement is utilized, fixing the ball on the glenoid to provide a fulcrum for the high molecular weight polyethylene tray placed on the humeral side (hence then name reverse since the ball is placed on the glenoid instead of the humerus).  Tremendous advances have been made in this technology since the FDA approved it in November of 2003.  I placed my first reverse total shoulder replacements in April 2004 and have performed more than 1300 of these operations since, as of November 2018.

If it is unclear, after thorough exam and diagnostic studies, as to the integrity of the cuff, I can make an intraoperative decision as to which design will work better, since I can place either prosthesis through the same 3 inch minimally invasive incision.

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