REVERSE TOTAL SHOULDER REPLACEMENT
What is a reverse shoulder replacement?
Every year, thousands of conventional total shoulder replacements are successfully done in the United States for patients with shoulder arthritis. This type of surgery, however, is not as beneficial for patients with large rotator cuff tears who have developed a complex type of shoulder arthritis called "Rotator cuff tear arthropathy." For these patients, conventional total shoulder replacement may result in pain and limited motion, and reverse total shoulder replacement may be an option.
A conventional shoulder replacement device mimics the normal anatomy of the shoulder: a plastic "cup" is fitted into the shoulder socket (glenoid), and a metal "ball" is attached to the top of the upper arm bone (humerus). In a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus.
A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.
(Left) Rotator cuff arthropathy.
(Right) The reverse total shoulder replacement allows other muscles — such as the deltoid — to do the work of the damaged rotator cuff tendons.
When is a reverse shoulder replacement advised?
Reverse total shoulder replacement may be recommended if you have:
- A completely torn rotator cuff that cannot be repaired
- Cuff tear arthropathy
- A previous shoulder replacement that was unsuccessful
- Severe shoulder pain and difficulty lifting your arm away from your side or over your head
- Tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain
The components of a reverse total shoulder replacement include the metal ball that is screwed into the shoulder socket, and the plastic cup that is secured into the upper arm bone.
How is a reverse shoulder replacement done?
This procedure to replace your shoulder joint with an artificial device usually takes about 2 hours. You will require a general anesthetic ± regional block. Your surgeon will make an incision either on the front or the top of your shoulder. Your orthopaedic surgeon will remove the damaged bone and then position the new components to restore function to your shoulder.
Reverse total shoulder replacement is a highly technical procedure. Your surgeon will evaluate your situation carefully and discuss the risks of surgery with you. Risks for any surgery include bleeding and infection. Complications specific to a total joint replacement include wear, loosening, or dislocation of the components. If any of these occur, the new shoulder joint may need to be revised, or re-operated on.
A typical follow-up x-ray of a reverse total shoulder replacement.
What to expect after a reverse shoulder replacement ?
After rehabilitation, you will most likely be able to lift your arm to just above shoulder height and bend your elbow to reach the top of your head or into a cupboard. Reverse total shoulder replacement provides outstanding pain relief and patient satisfaction is typically very high.
For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterwards on low shelves. When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry. If you will not have any support at home immediately after surgery, you may need a short stay in a rehabilitation facility until you become more independent.
The dressings are waterproof, so you can shower (out of the sling) resting your operated arm on your abdomen or by your side. You will need to wear a sling for 6 weeks. During this time, you can come out of the sling three times a day to do your physiotherapy exercises. Driving is allowed once you come out of your sling. You will be able to resume your full activities including progressive return to sporting activities in the next 6 months.