Reverse Total Shoulder Replacement
This surgery removes the damaged or diseased ball end of the humerus and replaces it with an artificial joint that completely reverses the structure of the shoulder. It is designed for patients who have exhausted all other treatment options. Patients usually spend two to four days in the hospital after the surgery.
Reverse total shoulder replacement is a surgical intervention that aims to repair a condition known as rotator cuff tear arthropathy. This is different than total shoulder replacement because it switches the formation of the glenoid-humeral joint. Naturally, the "ball" of the joint exists as the terminal end of the humerus, but after this procedure the glenoid will be changed into a spherical object that the humerus head can articulate around. This allows the deltoid muscle to lift the arm instead of the torn rotator cuff.
Although this is a very effective method for relieving pain at the shoulder joint, it is normally the last option considered. It is still an invasive surgery that resurfaces the bones, which can be very risky, especially in patients most likely to require this surgery. The bones of elderly individuals are continually weakening as they age, so it is important for doctors to take this into account when determining if the surgery is worthwhile. Additionally, the patient may no longer be able to lift their arm more than a 90 degree angle after this procedure.
Reasons for Reverse Total Shoulder Replacement
Total shoulder replacement surgery is performed on thousands of patients each year who are experiencing pain and other symptoms of shoulder arthritis. However, traditional total shoulder replacement is not always beneficial for patients with large rotator cuffs, or those who have developed a type of shoulder arthritis known as cuff tear arthropathy. For these patients, conventional total shoulder replacement may only result in greater pain and limited motion, making reverse total shoulder replacement a viable treatment option.
Candidates for Reverse Total Shoulder Replacement Surgery
In most cases, candidates for reverse total shoulder replacement surgery have previously undergone an unsuccessful shoulder replacement. Patients may also benefit from reverse total replacement shoulder surgery if they have a torn rotator cuff or severe shoulder pain. While these injuries may occur in patients of any age, they are more frequently found in elderly individuals since the bones continually weaken as part of the aging process.
Reverse total shoulder replacement is only considered when nonsurgical treatments such as rest, physical therapy, medication and cortisone injections have all failed to provide pain relief. Because reverse total replacement surgery involves resurfacing bones, patients must also be educated about the potential problems associated with the procedure prior to undergoing surgery.
The Reverse Total Shoulder Replacement Procedure
Reverse total shoulder replacement surgery is a somewhat different procedure from traditional shoulder replacement surgery. During a traditional shoulder replacement surgery, the normal anatomy and function of the shoulder is restored by inserting an artificial joint device into the shoulder socket (glenoid). A metal ball is then attached to the top of the upper arm bone (humerus).
During reverse total shoulder replacement, however, the metal ball is instead fixed into the socket, and the artificial joint is attached onto the upper part of the humerus. The damaged bone is then removed and repositioned. As with total shoulder replacement surgery, the balance and function of the shoulder is restored through the placement of the artificial devices. Reverse total shoulder replacement is performed in a hospital, with the patient under either general or regional anesthesia. The procedure usually takes 2 hours to complete.
Risks of Reverse Total Shoulder Replacement Surgery
The possible risks of reverse total shoulder replacement surgery include:
- Dislocation, degeneration or loosening of the artificial joint replacement over time
- Continued limited mobility of the arm
In some cases, complications following surgery may require a second, corrective operation.
Recovery from Reverse Total Shoulder Replacement Surgery
Immediately after surgery, patients are given antibiotics to prevent infection as well as pain medication to reduce discomfort. Patients will need to wear a sling to support the arm and avoid strenuous activities that place pressure on the shoulder for about 6 weeks. Physical therapy can help restore both strength and flexibility to the shoulder. Although some patients may be unable to lift the affected arm in certain ways following this procedure, most will experience significant pain relief and an improved range of motion from reverse total shoulder replacement.