Reverse Shoulder Replacement
Reverse total shoulder replacement, is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear. It is also utilized in certain complex revision situations where a anatomical shoulder replacement is not an option.
The shoulder joint is a ball and socket joint formed by the union of the head of the upper arm bone (humerus) and the shoulder socket (glenoid). The rotator cuff is a group of four tendons that join the head of the humerus to the deeper shoulder muscles to provide stability and mobility to the shoulder joint.
When the rotator cuff is torn, it can cause wear and tear to the shoulder joint and lead to shoulder arthritis. Conventional surgical procedures such as anatomic total shoulder joint replacement have been shown to be ineffective in the treatment of Rotator cuff arthropathy.
Conventional shoulder replacement surgery involves replacing the ball of the arm bone (humerus) with a metal ball and the socket (glenoid cavity) of the shoulder blade (scapula) with a plastic socket. If this surgery is used to treat rotator cuff arthropathy, it may result in loosening of the implants due to the torn rotator cuff. Reverse total shoulder replacement provides an alternative option that may be used in such cases.
In reverse total shoulder replacement, the placement of the artificial components is essentially reversed. In other words, the ball is placed on the glenoid cavity of the shoulder blade (scapula) and the socket is placed on top of the arm bone. This design makes efficient use of the deltoid muscle, the large shoulder muscle, to compensate for the torn rotator cuff.
Patients with rotator cuff arthropathy may feel pain and weakness within the involved shoulder. Patients may have had a prior rotator cuff repair or a history of multiple repairs. Some patients however may not have a history of prior surgery or trauma. The most common symptom is the inability to raise the arm above the shoulder to perform overhead activities.
Ideal candidates for surgery
Reverse total shoulder replacement may be recommended for the following situations:
- Completely torn rotator cuff that cannot be repaired, in an older patient population
- Presence of cuff tear arthropathy (arthritis secondary to a large irreparable rotator cuff tear).
- Previous unsuccessful shoulder replacement
- Severe shoulder pain and difficulty in performing overhead activities
- Continued pain despite other treatments such as rest, medications, cortisone injections, and physical therapy
Reverse total shoulder replacement surgery is performed with the patient under general anesthesia. Regional anesthesia with a nerve block is also often used to help with pain control on the day of surgery.
- Your surgeon makes an incision over the affected shoulder to expose the shoulder joint
- The humerus is separated from the glenoid socket of the scapula (shoulder blade)
- The arthritic parts of the humeral head and the socket are removed and prepared for insertion of the artificial components
- The artificial components include the metal ball that is fixed to the shoulder socket and the plastic cup that is inserted into the upper arm bone
- The artificial components are then fixed in place
- The joint wound is closed in layers from deep to superficial
After the surgery, pain medications and antibiotics are prescribed to control pain and reduce the risk of infection. Your arm will be be secured in a sling for a period of up to 6 weeks. The rehabilitation program includes physical therapy, and is very important to strengthen and provide mobility to the shoulder. Typically, you will not be allowed to perform any activities requiring resistance or weight bearing with the affected arm for 12 weeks. Do not push yourself up out of a chair or bed using your affected arm. During the period, the physical therapy protocol will progress from immobilization to protect the shoulder, passive range of motion followed by active range of motion. Elbow, hand and wrist motion is allowed early to avoid stiffness.
Risks and complications
As with any major surgery, there may be potential risks involved:
- Anesthetic complications such as nausea, dizziness and vomiting, or rare but more serious complications including heart attack, stroke, and death.
- Infection of the wound
- Dislocation, requiring repeat surgery
- Fracture of the humerus or scapula
- Damage to blood vessels, nerves or muscles
- Failure to relieve pain
- Pulmonary embolism (Blood clot)
- Wear and tear of prosthesis