Siouxland Shoulder Specialist on Reverse Total Shoulder Replacement
Mar 29, 2018 06:00AM ● Published by Alyssa McGinnis
There are seventeen muscles in the human shoulder, giving a healthy shoulder the greatest range of motion of any joint in the body. But, according to Brian Johnson, MD, an orthopedic surgeon at CNOS in Dakota Dunes who specializes in shoulder care, four of those muscles—the muscles that comprise the rotator cuff—cause more problems than the other thirteen combined.
Johnson has become a regional expert in a procedure that attempts to get around one of the problems inherent in a diseased or injured rotator cuff: the fact that it is unlikely to support a standard total shoulder replacement.
“The rotator cuff is what holds the standard total shoulder in place,” says Dr. Johnson.”But if you have a tear, it’s going to rock up and down and cause the component to fail. It also increases dislocation rates and causes pain.”
Like those with rotator cuff problems, patients with severe arthritis, complex fractures, glenoid bone stock problems, or total shoulder replacements that need revision are also not good candidates for standard total shoulder replacements. Fortunately for patients with these issues in the Siouxland area, Dr. Johnson has had great success performing reverse total shoulder replacements, which were FDA approved in 2003.
The procedure reverses the ball and socket of the shoulder joint, affixing a metal ball to the socket and a plastic cup to the upper end of the humerus. Johnson trained on the procedure in France where it was developed and has been used for the last 30 years. He has performed more than 500 reverse total shoulders over the last 11 years.
“I wanted to see what the limitations and applications of this reverse procedure were,” says Johnson, who was fellowship trained in advanced shoulder reconstruction and sports medicine in San Diego. Dr. Johnson spent time in Nice and Lyons, France learning the reverse total shoulder technique from Dr. Gilles Walch and Dr. Pascal Boileau, international pioneers in shoulder diseases and treatments. He has also spent time with a number of US shoulder surgeons.
“I think if you keep yourself open, you can learn something from everyone,” says Johnson. “I have learned a lot from other people’s mistakes, so I pay very careful attention to positioning.”
His careful observation has paid off. Of the 500 reverse total shoulders he has performed—about 70 of which were revisions of standard total shoulder replacements—there have been only four dislocation, a rate of less than one percent (compared to a national average of 3 to 31 percent). The reverse procedure has lowered the risk of complications with revision surgery by 20 percent.
“In France, which is a much more mature market, 95 percent of shoulder replacements are reverse total shoulders,” says Johnson. “It offers options for something that didn’t have options and there is some evidence that it may even be better. So it is a rapidly evolving area of shoulder science.”