TSR VS RSR

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Understanding the Difference Between Total Shoulder Replacement and Reverse Shoulder Replacement

Welcome to the Boltuch Orthopedics blog! Shoulder pain and dysfunction can significantly impact your quality of life. For severe shoulder conditions, surgical intervention might be the best option to restore function and alleviate pain. Today, we’ll delve into the differences between two common surgical procedures: Total Shoulder Replacement (TSA) and Reverse Shoulder Replacement (RSA).

What is Total Shoulder Replacement?

Total Shoulder Replacement (TSA), also known as Anatomic Shoulder Replacement, is a surgical procedure designed to treat severe arthritis and other degenerative conditions of the shoulder joint. In TSA, both the ball (humeral head) and the socket (glenoid) of the shoulder joint are replaced with prosthetic components that mimic the natural anatomy of the shoulder. To be a candidate for a total shoulder replacement, the rotator cuff must be intact.

Indications for TSA:

Severe osteoarthritis
Rheumatoid arthritis
Post-traumatic arthritis

How TSA Works:

The damaged humeral head is removed and replaced with a metal ball attached to a stem.
The glenoid cavity is prepared, and a polyethylene socket is implanted to accommodate the new humerus.
This restores the normal anatomy and mechanics of the shoulder, allowing for improved range of motion and pain relief.

Recent Advancements in TSA:

3D Planning Technology: Utilized prior to surgical intervention to determine the best sizing and placement of implants, improving outcomes.
Stemless Technology: A cutting-edge, bone-conserving approach now used in total shoulder replacement.

What is Reverse Shoulder Replacement?

Reverse Shoulder Replacement (RSA), or Reverse Shoulder Arthroplasty, is a specialized procedure often used for patients with rotator cuff tear arthropathy, severe arthritis with rotator cuff deficiency, and complex fractures. In RSA, the normal ball-and-socket structure is reversed: a ball is placed on the glenoid (socket), and a socket is placed at the top of the humerus.

Indications for RSA:

Irreparable rotator cuff tears
Cuff tear arthropathy
Failed previous shoulder surgery, including TSA
Complex fractures of the shoulder
Severe arthritis with rotator cuff deficiency
Severe glenoid wear patterns

How RSA Works:

The damaged humeral head is removed and replaced with a socket.
The glenoid cavity is prepared, and a metal ball is implanted to replace the socket.
This reversal changes the mechanics of the shoulder. In the setting of significant rotator cuff tears, the deltoid muscle compensates for the deficient rotator cuff, providing stability and improved function.

Key Differences Between TSA and RSA

Indications:

TSA: Best for patients with arthritis and intact rotator cuffs.
RSA: Suitable for patients with irreparable rotator cuff tears, complex fractures, or previous failed shoulder surgeries.

Outcomes:

TSA vs. RSA: Both procedures can significantly improve pain and shoulder function. One key difference is the potential for decreased internal rotation (reaching behind your back) with RSA. However, studies show that RSA may last longer than TSA as it does not rely on the rotator cuff. Both procedures can enable a return to functional activities, including golf, swimming, tennis, and pickleball.

Recovery:

The postoperative protocol for both procedures includes wearing a sling for six weeks, which is crucial for the adherence of the implant to the body to prevent loosening over time.

Choosing the Right Procedure

The decision between TSA and RSA depends on various factors, including the condition of the rotator cuff, the severity of arthritis, age, activity level, and overall health. At Boltuch Orthopedics and Orthopedic Associates of West Florida, we conduct a thorough evaluation, including physical exams, imaging studies, and discussions about your lifestyle and goals, to determine the most appropriate treatment for you.

Andrew Boltuch, DO

Orthopaedic Associates of West Florida

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If you're experiencing shoulder pain or have been diagnosed with a severe shoulder condition, early intervention can significantly improve your chances of a full recovery and restore your quality of life. At Boltuch Orthopedics, we specialize in advanced treatments for shoulder injuries, including Total Shoulder Replacement and Reverse Shoulder Replacement.