Expert: Alfred Cook, MD

Dr. Cook has been serving The Villages and surrounding community for 15 years and specializes in assessment and treatment of various shoulder issues so patients can return to doing the activities they enjoy.

Respected as a leader in cutting edge approaches to shoulder surgery and sports injuries, Alfred Cook, MD, is the chief of orthopedic surgery at UF Health Spanish Plaines Hospital and serves as medical director for the TLC Surgical Center. 

What is Reverse Total Shoulder Arthoplasty (RTSA)?

A specialized form of shoulder replacement, RTSA utilizes the latest technology. This surgery takes into account a patient’s arthritis and soft tissue damage and addresses those issues simultaneously. In the U.S., this procedure was introduced over the last 20 years. Dr. Cook partnered with leading industries to design the implants used in RTSA. 

How is RTSA different from standard shoulder replacement?

After the surgeon removes damaged parts of the shoulder, they are replaced with artificial components, reversing the position, so the ball is now on the socket side of the shoulder joint. To accommodate this change, the socket is placed on the arm side of the joint and supported by a metal stem in the humerus. The surgeon’s decision to use RTSA comes down to the integrity of the rotator cuff. If there are abnormalities with the rotator cuff, including full or partial tears, especially with associated arthritis, the patient would not be a candidate for a standard total shoulder, which requires an intact rotator cuff to be successful. 

Who is a good candidate for RTSA?

The ideal candidate is a patient who has rotator cuff tears that cannot be repaired, or osteoarthritis that has led to a significant disformity in the shoulder. The reason most patients come to see Dr. Cook is because they are in pain, often caused by a combination of these issues.

In some cases, patients with Rheumatoid Arthritis (RA) need the surgery because this autoimmune disease can attack the shoulder and break down the joint and healthy tissues. A severe fracture that is unlikely to heal correctly can make a patient a good candidate for this surgery. RTSA may also be recommended when symptoms don’t improve with medication, injections and physical therapy.