Reverse Shoulder Replacement
“At this age, especially, I’m very cautious when I ride,” says the 86-year-old Palm Desert resident. But when she took a tumble in a nail salon of all places, she saw the painful irony in the circumstances of her fall.
“I had gone to get my nails done, stood up to wash my hands, and tripped,” she relates.
“In a split second I was on the floor, landing on my right shoulder. I knew I had fractured something - I could hear it,” she adds. “All those years of riding and I fall in a nail salon!”
The salon staff rushed to help her to her feet but Hebert, a retired nurse (she spent 28 years working at Eisenhower Health, including stints as a surgical nurse and manager of the orthopedics department), knew it was safer to stay put. From the floor, she used her smart watch, which she’d just gotten two weeks prior, to call 911. She was brought by ambulance to Eisenhower’s Tennity Emergency Department.
“They got me right in and called Dr. Otarodi, who was on call, to come in and see me,” Hebert recalls, noting that by this time it was 6:30 in the evening.
She was seen by Karimdad Amir Otarodi, MD, a board certified and fellowship-trained orthopedic surgeon who is part of Eisenhower Desert Orthopedic Center. He immediately ordered x-rays to assess the extent of the damage to her shoulder.
“She had a really bad shoulder fracture; it had broken into four or five pieces,” Dr. Otarodi explains. “Doing a repair or reconstruction on such a complex fracture would not heal well and produce a less-predictable result than a complete shoulder replacement.”
The procedure that Dr. Otarodi proposed to Hebert is called a reverse shoulder arthroplasty. In the human anatomy, the top of the arm bone (the humerus) fits into a socket on the shoulder blade. In a traditional shoulder replacement, a plastic lining, called an implant, is affixed to the socket. The surgeon removes the top of the humerus and inserts a metal stem with a ball on the end that fits into the socket, enabling smooth movement.
In a reverse shoulder replacement, the orientation of the ball and socket are reversed. The metal ball is attached to the socket and the socket implant is attached to the top of the arm bone. This approach has been shown to give patients more shoulder stability.
In fact, more than 70 percent of shoulder replacements in the United States today are reverse procedures and, notably, Eisenhower is one of the highest-volume centers in the country — underscoring the experience of its orthopedic surgeons.
What’s more, Eisenhower has a newer type of implant available designed specifically for patients who have sustained complex fractures (versus those who need a shoulder replacement due to arthritis). Manufactured by a well-established device company and fully FDA-approved, this newer implant is currently being studied to assess patients’ longer-term outcomes. Eisenhower is one of about eight sites in the nation enrolling patients in this study.
Hebert underwent outpatient reverse shoulder replacement surgery on September 8, 2023, the day after her fall, and was discharged to home that day. For the next two months, she wore a rigid sling to keep her shoulder in place. She also completed a rigorous eight-month physical therapy regimen and did strengthening and mobility exercises on her own in between twice-weekly PT sessions.
“I devoted my time to getting better and intended to do great,” she says. “I wanted to get back to normal and it worked.”
It has, indeed.
“I can do everything I did before,” Hebert says. “I can wash and curl my hair, raise my arm... it doesn’t bother me at all.
“And I’m back out at the ranch by 6 or 6:30 a.m. every day, working with Mr. Duke for three to four hours,” she continues, referring to her 28-year-old mustang. “I’m not riding but I walk him for at least 20 to 25 minutes - it’s good exercise in the sand. Plus, I’m stooping, bending and lifting to feed and care for him. Even grooming him is a workout, the motion of brushing with that arm. But I can do it all.”
Dr. Otarodi agrees.
“When the patient is compliant after surgery, they can achieve full range of motion, which she has,” he says. “She did a fantastic job.”
To learn more about Eisenhower Desert Orthopedic Center, visit EisenhowerHealth.org/EDOC.
For an appointment, call 760,773.4545.
