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Reverse Shoulder Replacement
What is a Reverse Shoulder Replacement?
Reverse shoulder replacement is a revolutionary type of surgery which is done in rare cases where the patients have had no solution from other procedures and have suffered for years. This complicated and extremely technical surgery, which was originally designed in the 1980’s in Europe, is performed by highly skilled and experienced surgeons. To understand Reverse Shoulder Replacement, we must understand the basic anatomy of the shoulder. Our shoulder is a ball and socket-type joint made up of two main parts – the humerus (ball) and glenoid (socket). A reverse shoulder replacement uses an artificial device to replace the damaged shoulder joint but in a reversed manner. It has the ball of the shoulder joint where the socket should be and the socket where the ball normally is. Thus, the anatomy is reversed.
Why opt for a Reverse Shoulder Replacement?
The reason for opting a reverse shoulder replacement rather than a conventional shoulder replacement is that a standard shoulder replacement surgery can be performed only when the muscles and tendon around the shoulder are intact. These muscles and tendons together form the rotator cuff which help with the movement and stabilization of shoulder. If these rotator cuffs are completely torn or gone, the normal shoulder replacement surgery cannot be performed. Reverse prosthesis can help such patients. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff to stabilize and move the arm. Although, it does not give the complete range of motion back, but it is improved over the motion previously lost due to the severe condition and gives significant pain relief.
Ideal cases for a Reverse Shoulder Replacement?
Completely torn rotator cuff
Failed Shoulder Replacements
Rotator Cuff Arthropathy
Reverse Shoulder Replacement – the procedure
Reverse total shoulder replacement surgery is performed by giving general anesthesia along with an interscalene nerve block to numb the shoulder and arm. An incision is made over the affected area to expose the shoulder joint. The humerus is separated from the glenoid socket of the scapula. The damaged parts of the humeral head and the socket are removed and prepared for the insertion of the prosthesis. After fixing the prosthesis, the joint capsule is stitched together and the wound is closed with sutures.
Is recovery and rehabilitation different?
The main factor in the recovery process is whether the surgery is a primary one or a revision one done to remove the old prosthesis and fix the new one. In case or revision procedures, the recovery takes comparatively longer time. Otherwise, the rehabilitation is similar to that of the standard shoulder replacement surgeries.
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Reverse Shoulder Replacement Procedure Explained
Q&As on Reverse Shoulder Replacement
1.What is reverse shoulder replacement?
Reverse shoulder replacement is a surgical process that involves reversing the ball and socket joint of your shoulder. It is recommended primarily for those individuals having shoulder fractures; damage in the tendon surrounding the shoulder, called rotator cuff; or shoulder arthritis. It assists in getting relief from pain and enhances functional abilities.
Moreover, your doctor might suggest this surgery in the following cases:
- When shoulder replacements fail
- A torn rotator cuff that can’t be treated with surgery
- Chronic shoulder dislocation
- Cancer in the shoulder joint
- Complicated fracture of the shoulder joint
2.How is reverse shoulder replacement different from regular shoulder replacement?
The primary difference between reverse shoulder replacement and regular shoulder replacement is the position of the artificial joint in the patient’s shoulder. With regular shoulder replacement, the damaged parts of your shoulder joint, the ball, and the socket are replaced with artificial ones in the same positions as the natural joint. Whereas in reverse shoulder replacement, there is a change in the position of the ball and socket. The artificial ball is attached to the socket part of the joint, and then the artificial socket is positioned where the natural ball is present.
When the position of the ball and socket is reversed through surgery, it allows various muscles to carry out the function of the damaged ones, enhancing the movement and stability of the shoulder. This brings in changes in how the shoulder rotates at its center and uses various muscles, such as the deltoid, to offer better movement and steadiness. It is best for those who have compromised rotator cuff muscles or complicated conditions of the shoulder.
3.How is recovery after reverse shoulder replacement?
After surgery, you will wake up with a numbed arm on a sling due to nerve blockage. You will be given medicines for controlling pain while your nerve blockage wears off in the next 12–24 hours. A day after the operation, along with a routine blood test, you need to do a shoulder X-ray to confirm that the implants are in good condition.
You will be given blood thinning injections the day of surgery and till you are up and about post your operation. Your physiotherapist will discuss with you the rehabilitation plan; most patients are allowed to go home a day or two post surgery. It’s necessary to keep the wounds dry and must be covered using a dressing for about two weeks. Patients can return to work in 3–4 weeks and all household day-to-day activities after 8–12 weeks. Heavier activities are allowed after 16–24 weeks.
4.How is reverse shoulder replacement done?
Doctors carry out this surgery by using general anesthesia. In this procedure, the damaged surface of your shoulder joint is replaced. It mainly reverses the normal ball and socket shoulder arrangement, due to which it is called reverse shoulder replacement. Here the damaged bone is replaced and the shoulder function is restored. Screws present on the socket side help in holding on socket onto the shoulder blade; this screw then fastens the ball to the socket. The whole procedure takes about 2 hours to complete. The length of the stay in the hospital is around 5 days, which is 1 day before the surgery and 3–4 days post surgery.
5.What are the risks involved with reverse shoulder replacement?
The success rate of reverse shoulder replacement surgery is high. However, there are certain risks and side effects involved with it, such as:
Infection
Even if rare, there is a chance of superficial wound infection.
Damages of nerves and blood vessels
This can occur in regions that surround the shoulder, although such cases are sporadic.
Pain and less mobility
In rare cases, pain might persist and full shoulder movements might be restricted.
Anesthesia risks
Some individuals might react differently to anesthesia, even if it is rare.
Shoulder joint dislocation
It is a rarely occurring risk.
Repeat surgery
After about 10 years, repeat surgery might be required based on the stability of the shoulder.
Metal implants loosening
This is a rare complication that might happen after some years of the surgery.
