Reverse total shoulder replacement, also known as reverse total shoulder arthroplasty, is an elective surgical procedure whereby the repair of the shoulder’s ball and socket prosthesis is changed and placed differently (reversed) from the normal shoulder replacement. In reverse replacement the metal ball prosthesis is placed on the socket cup joint while the plastic prosthesis is placed at the end of the upper arm bone.
In a regular shoulder replacement procedure, the prosthesis used are made of a metal ball which is re-placed in the humerus bone (arm bone) and a plastic socket is re-placed in the socket joint located at the shoulder blade (scapula).
Reverse total shoulder replacement is effective for patients who have aggregated arthritis. In such a case the rotator cuff tear is large which forms a type of arthritis known as cuff tear arthropathy. This type of reverse replacement is performed because it is dependent on different muscles such as the deltoid muscle to assist in the motion of the arm. This is as a result of lack of normal functioning of the rotator cuff muscles whereby the individual has formed cuff tear arthropathy and large rotator cuff tear.
Candidate for Reverse Total Shoulder Replacement
Reverse total shoulder replacement is recommended for individuals who may have:
- A cuff tear arthropathy
- Rotator cuff that has been torn completely beyond repair
- A severe joint fracture of the shoulder
- Tumor at the shoulder joint
- Unsuccessful initial conventional shoulder replacement
- A severe dislocation of the shoulder
- Difficulty in having range of motion such as lifting the arm over the head
- Undergone ineffective non-surgical treatments such as medications and physiotherapy
Diagnosing the Need for Reverse Total Shoulder Replacement
Reverse total shoulder replacement is diagnosed when the loss of function of the shoulder is progressive. The doctor performs a physical examination to establish if the joint is crushing or rubbing against each other. An x-ray is also performed to show the severity of the damage and if there is any presence of fragments of the damaged bones.
Pre-op Guidelines for Reverse Total Shoulder Replacement Surgery
Before the procedure, the patient is required to visit his/her doctor for an evaluation of their medical history and any medications being taken at that time. One should stop using some medications such as non-steroidal anti-inflammatory drugs before the surgery as they can cause excessive bleeding during the procedure. Patients with chronic medical conditions are examined to ascertain if they are fit for the surgery in order to avoid complications.
The Procedure
The procedure is performed under general and/or local anesthesia and it takes approximately two hours (depending on the severity of the damage). The area to be operated on should not have any underlying conditions like sores.
During the procedure, an incision is made at the top or front part of the shoulder and then the damaged humerus bone (upper arm bone) is removed. The prosthesis plastic socket is then attached and screwed on to the shaft of the arm bone. The socket part of the shoulder blade is also removed, and the metal ball attached to it.
The goal of the surgery is to regain function of the shoulder, relieve pain and be able to return to normal activities.
Possible Risks Involved in Reverse Shoulder Replacement
Just like any other surgical procedure, there are some possible risks that can occur after reverse total shoulder replacement surgery. These include:
- Injury to the blood vessels and nerves
- Bleeding
- Infection which can lead to a revision of the procedure if not treated early
- Rigidity of the shoulder joint due to lack of motion in the first few weeks of healing
- Lack of attachment of the muscles and tendons, which may release the prosthesis
Post-op Care and Recovery
After the surgery the patient is provided with a sling to support the arm in order to avoid movement, which may lead to more damage.
The patient is instructed to perform gentle motion exercises such as stretching of the arm, leaning the shoulder downwards and then resting it on the table. Physiotherapy is also recommended after a few weeks in order to regain strength and flexibility of the shoulder. He/she is also advised against performing certain movements and carrying heavy weights, positioning the arm behind the back or lifting it above shoulder height.
Next Step
Our board-certified orthopedic surgeons at King’s have extensive knowledge of the full range of shoulder disorders and will help you find the ideal medical solution for your condition. You can get in touch by filling in the form below.
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