Q: Can anyone get one of those new reversed shoulder replacements? I had a regular shoulder implant that didn't work so I need to replace the replacement.

A: The reverse shoulder arthroplasty is a new enough procedure that surgeons are still studying who would benefit from this implant. The procedure is called a reverse shoulder arthroplasty.

The round ball-shaped bone that normally fits into the shoulder socket is removed and replaced with an artificial cup. The anatomic socket is replaced with a titanium round head. The two parts of the shoulder (round head and socket) are reversed in location.

Although it was designed for patients with massive rotator cuff tears that cannot be repaired, it has also been used for patients with severe bone loss, failed shoulder replacement, and humeral fractures that did not heal. Given that criteria, with your failed shoulder replacement, you might qualify for a revision surgery using the reverse implant.

The main indications for this surgery are pain, loss of shoulder motion, and failed conservative (nonoperative) care. A rotator cuff tear that is too large to repair is another criterion for the use of the reverse shoulder arthroplasty.

It may not be the best choice for patients with pain but preserved motion (more than 90-degrees of shoulder elevation). Experts in this area suggest trying other options first for this type of situation. For example, rotator cuff repair or debridement should be considered. This doesn't seem to describe your particular situation.

Continued improvements in the design of the reverse shoulder implant and in surgical techniques will likely yield improved outcomes and greater implant survival in years to come.

Reference: Philip Mulieri, MD, et al. Reverse Shoulder Arthroplasty for the Treatment of Irreparable Rotator Cuff Tear Without Glenohumeral Arthritis. In The Journal of Bone and Joint Surgery. November 3, 2010. Vol. 92A. No. 15. Pp. 2544-2556.