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Robert Zanotti MD Is First Lorain County Ohio Orthopedic Surgeonto...

Until recently, patients in serious need of shoulder replacement were told they weren'st candidates for surgery if they didn'st have an intact rotator cuff -- the group of muscles and their tendons that stabilize the shoulder, says board-certified orthopedic surgeon Robert Zanotti, MD (http://www.center4orthopedics.com/physicians/rzanotti).

Now, a revolutionary procedure called reverse total shoulder replacement (http://www.center4orthopedics.com/procedures/shoulder-replacement) can help these patients live a normal life, says Dr. Zanotti, who traveled to France with his brother, orthopedic surgeon Daniel Zanotti, MD (http://www.center4orthopedics.com/physicians/dzanotti), to be trained in the technique. Only a small number of leading orthopedic surgeons perform reverse total shoulder replacement in the U.S.

Reverse total shoulder replacement can help patients with failed rotator cuff repair and shoulder arthritis, Dr. Zanotti explains. Individuals with a broken shoulder that did not heal properly are also candidates for this procedure. Other patients have reverse total shoulder replacement after a failed partial or complete traditional shoulder replacement.

For Robert Knight, 78, a retired air traffic controller from Elyria, Ohio, reverse total shoulder replacement has relieved excruciating shoulder pain and restored his ability to use his left arm. Knight fell off a ladder in 2006 and severely tore the rotator cuff in his left shoulder. He had arthroscopic surgery and a full open procedure, but doctors still could not restore his rotator cuff.

I was in constant pain and couldn'st move my upper arm, Knight recalls. I couldn'st use my left hand. To put my hand on the table, I had to lift it up with my other hand. I thought I was going to have to live the rest of my life with my shoulder the way it was. I had such terrific pain that I had to do something -- I couldn'st take it anymore.

Then a friend saw an article about reverse total shoulder replacement and Knight decided to see if the procedure could help him. He turned out to be a prime candidate.

Patients with a failed rotator cuff develop shoulder arthritis caused by cartilage rubbing on bone, Dr. Zanotti explains. Many times, their pain and weakness get to the point where they can'st lift their arms at all. These patients typically get cortisone injections, take pain medications for years and have been told, 'sThat'ss the way you'sve got to live.'s Not anymore. Reverse total shoulder replacement allows us to fix shoulders like these, so patients's pain is relieved and they can lift their arms again.

The shoulder is a ball-and-socket joint; the rounded portion of the upper arm is the ball and a shallow, dish-shaped structure attached to the shoulder blade is the socket, Dr. Zanotti explains. A reverse total shoulder replacement reverses the ball and socket -- that is, the ball portion of the replacement joint is attached to the shoulder blade and the cup, or socket, is attached to the upper arm. This uniquely positions the arm back in the socket.

Reverse total shoulder replacement allows the joint to maneuver without a functional rotator cuff, Dr. Zanotti adds. The procedure also relieves the pain of a torn rotator cuff caused by cartilage rubbing on bone. After reverse total shoulder replacement, patients can lift their arms using their deltoid muscle -- the triangular muscle on the cap of the shoulder -- rather than using their rotator cuff.

After his reverse total shoulder replacement, Knight went through three months of physical therapy. His range of motion returned to function quickly and he began strength training at six weeks, says physical therapist Sara Faris.

Now I can do just about everything, says Knight. I raise a garden, mow the lawn, plant shrubs, go hunting and fishing -- and I can lift my three great-grandchildren! he says.

For more details on reverse total shoulder replacement, visit www.center4orthopedics.com/procedures/shoulder-replacement. To schedule a consultation with Dr. Robert or Daniel Zanotti or any of the board-certified orthopedic surgeons at Northeast Ohio'ss Center for Orthopedics, call 440.329.2800.

The Center for Orthopedics, part of EMH Regional Healthcare System, offers the most comprehensive bone and joint care in Cleveland'ss west side, western Cuyahoga County and Lorain County, Ohio. Complete orthopedic care is available from an expert team of five advance-trained, board-certified orthopedic surgeons at offices in Sheffield Village, Oberlin and Westlake, Ohio. Call 440.329.2800 or visit www.center4orthopedics.com.

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