The Reverse Shoulder Replacement is a special kind of shoulder replacement. A Shoulder Replacement is surgery to replace the bones of the shoulder joint with artificial joint parts.
Your shoulder joint is a type of ball and socket joint. The ball is the end of your humerus (upper arm bone) called your humeral head and the socket is part of your shoulder blade (scapula) called your glenoid. During a total shoulder replacement, the round ball of your arm bone (humeral head) and the socket (glenoid) are replaced.
An anatomical shoulder replacement uses a metal ball on the top of the arm bone (humerus), and a plastic / metal socket on the shoulder blade (scapula). This is similar to how our body is designed with a ball-and-socket shoulder joint.
The reverse shoulder replacement uses a ball-and-socket joint as well, but their positions are ‘reversed’. That is, the ball is placed on the shoulder blade (scapula), and the socket is placed on top of the arm bone (humerus).
Who is this operation for?
In patients with rotator cuff tear arthropathy, the rotator cuff does not work normally, and the deltoid can help make up for this deficiency. By reversing the ball and the socket, the deltoid muscle becomes more able to lift the arm up overhead, and compensate for the torn rotator cuff.
The reverse shoulder replacement was specifically designed for a problem called rotator cuff tear arthropathy. Rotator cuff tear arthropathy is a problem that occurs when a patient has both shoulder arthritis and a rotator cuff tear.
The rotator cuff is the group of tendons and muscles that surround the shoulder joint. These muscles and tendons are important in performing shoulder tasks (such as lifting your arm overhead), and keeping the ball of the ball-and-socket shoulder joint centred. When the rotator cuff is torn, the shoulder can wear out, leading to shoulder arthritis.
What are the benefits of the operation?
Who is a good patient for a reverse shoulder replacement?
Patients interested in a reverse shoulder replacement must have severe shoulder arthritis, and a chronic rotator cuff tear. Patients who do not have this combination of conditions can usually undergo other surgical procedures to address their problem.
Other factors that influence the decision to perform a reverse shoulder replacement include the function of the deltoid muscle (that must be working well), the age of the patient, and the functional demands of the patient. In general, reverse shoulder replacements are designed for patients with limited activity demands.
Patients interested in having this procedure should discuss all of their options with their orthopaedic surgeons. Certainly a reverse shoulder replacement should only be performed if simpler, non-operative treatments have failed to alleviate symptoms. Patients should as their doctor about his or her experience with this procedure, as it is still a relatively new surgical technique.
Risks of not having the surgery
Complications
The risks and complications of a Reverse Shoulder Replacement include:
- Infection – This is a potential complication of any surgery. Infection may occur around the wound site, which is treated with antibiotics. It may also occur in the deeper tissues, which may require more surgery.
- Damage to nerves – Nerves involving sensation and movement in the shoulder and arm may be damaged during surgery. This complication is uncommon, and nerves may recover if damaged.
- Damage to blood vessels – Veins supplying the arm may be damaged during the procedure. Again, this is an uncommon complication.
- Stiffness of the shoulder
- Revision – More surgery may be required in the replaced shoulder. This may be due to loosening of implants, wearing down of joint surfaces, or dislocation of the joint.
For more information on potential risks of any surgery, see Complications of Surgery.
Are there problems with a reverse shoulder replacement?
Reverse shoulder replacements have been used for more than a decade in Europe, but have only been used in the United States since 2004 when they became FDA approved. While there is very promising data on use of these implants, it is still considered a relatively new design, and more investigation is needed.
Leading shoulder surgeons have called the reverse shoulder replacement procedure a “high-risk, high-reward” option for patients with a rotator cuff tear arthropathy. Recent studies have found a complication rate of 25 to 50% associated with this surgery. Complications can include loosening of the implants, instability or dislocation of the ball from the socket, and persistent pain.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- Shoulder x-ray
- Shoulder ultrasound
- Shoulder MRI
- blood tests
- Xray of your Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery
About the Operation
The procedure to remove your shoulder joint with a prosthetic one takes approximately two hours.
After the Operation
After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room. Most people wake up fully when back in their rooms on the ward.
Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery.
You will likely need to be in hospital for between 1-3 days. During this time you will receive antibiotics and pain relief (see Post-Operative Analgesia).
Recovery and Rehabilitation
Recovery
Avoid soaking the wound in water until it has completely dried. If there is any redness or pus around the wound, it is important to call your doctor immediately.
Most people are able to do simple daily tasks at home within 2 weeks of the operation. Driving a car is not recommended for 2-4 weeks after surgery.
Rehabilitation
You will be required to wear a sling for 6 weeks. During this time, you will be given passive and active range of motion exercises to perform. After the initial 6 week period, you will be given strengthening exercises to do on top of this.