Reverse Total Shoulder Replacement
What is reverse total shoulder replacement?
A reverse total shoulder (also called reverse total shoulder arthroplasty) is a type of joint replacement surgery. When shoulder function deteriorates due to arthritis, doctors often can restore its function through shoulder replacement surgery. An orthopedic surgeon can choose between two types of shoulder replacement surgery: traditional or reverse. Reverse shoulder replacement surgery generally is reserved for people who do not qualify for traditional shoulder replacement due to irreparably damaged rotator cuff tissue or other issues.
The shoulder is a ball-and-socket type of joint that provides the widest range of movement of any joint in the body. The joint consists of a bony ball at the top of the arm bone (humerus) that rests inside a relatively shallow socket (glenoid) in the shoulder blade (scapula). The shoulder is powered through the coordinated efforts of a variety of muscles and tendons, including the rotator cuff. Instead of re-creating a ball on the humerus that fits into a socket on the scapula, a reverse shoulder prosthetic (artificial joint) puts the ball on the scapula and the socket on the humerus. This style of joint replacement uses the deltoid muscles—not the rotator cuff—to provide strength and positioning for the new joint.
Why is reverse total shoulder replacement performed?
If the shoulder joint fails due to arthritis, overuse injury, or trauma, a doctor may perform shoulder replacement surgery to restore the joint and pain-free movement. Traditional shoulder replacement surgery does not work for people whose rotator cuff is torn beyond repair. When surgeons cannot use the rotator cuff to power an artificial shoulder joint, they perform a reverse total shoulder replacement that employs other shoulder muscles (the deltoids) instead.
Not everyone qualifies for a reverse total shoulder procedure. In general, your doctor may recommend this surgery due to:
Chronic dislocation of the shoulder
Cuff tear arthropathy, a condition in which the rotator cuff is torn and also exhibits significant other degeneration including displacement of the humerus from the glenoid
Previous shoulder replacement surgery that was unsuccessful
Severe shoulder pain and loss of mobility
Shoulder trauma such as complex fractures
Torn rotator cuff that cannot be repaired
Unsuccessful conservative treatments
Except in the case of sudden shoulder trauma that must be repaired immediately, a doctor usually will exhaust all conservative treatment options before suggesting arthroplasty. Some treatments your doctor may recommend are:
Medications including nonsteroidal anti-inflammatory drugs like ibuprofen
Resting the shoulder from activities that make the pain worse
Like traditional shoulder replacement surgery, a reverse total shoulder procedure carries certain risks. Your doctor will discuss all the risks and benefits of this procedure with you. It’s a good idea to ask questions about the rehabilitation requirements after surgery and to what degree the surgery may improve your quality of life.
Who performs reverse total shoulder replacement surgery?
Orthopedic surgeons perform these types of procedures. They use their years of experience to evaluate your condition and recommend the shoulder replacement approach that is best suited to treat your pain and loss of joint function. Consider the orthopedic surgeon’s experience performing reverse total shoulder procedures. It differs significantly from traditional shoulder replacement surgery so you need a surgeon who performs reverse total shoulders on a regular basis with a very low risk of complications from the surgery. After surgery, you will work closely with a physical therapist to perform exercises designed to build strength and mobility in your new shoulder.
How is reverse total shoulder replacement surgery performed?
Shoulder replacement surgery is an open type of surgery with a significant incision. This procedure takes place in a hospital, where you will stay for at least one day after surgery. The surgery itself usually takes about two hours. The surgeon removes damaged bone, cartilage, and other tissues and prepares the surfaces for the artificial joint components—a combination of metal and plastic parts—for a reverse total shoulder procedure.
What to expect the day of your reverse total shoulder surgery
Details vary based on the surgical center or hospital, but in most cases, the day of surgery you will:
Check in and fill out paperwork.
Receive an intravenous (IV) line for fluids and medications in a preoperative holding room.
Discuss your anesthesia choices with an anesthesiologist or nurse anesthetist. Shoulder replacement surgery may be performed using general or regional anesthesia.
Visit with your surgeon to review the procedure and what happens afterwards. Your surgeon should mark the surgical area and may initial it with a felt-tip pen.
Be transported to the operating room. The anesthesiologist will give you oxygen through a mask and start your anesthesia.
Wake up after the procedure in a recovery area before going to your hospital room.
After surgery, you will receive pain medication, either by your IV line or as a pill to swallow. Some doctors may put numbing medicine directly into the shoulder joint during surgery to minimize your discomfort afterwards. You may also notice a tube extending from the surgical wound that drains fluids from the shoulder. If the doctor sends you home with this surgical drain, your nurse will instruct you about how to empty it and record the output.
What are the risks and potential complications of reverse total shoulder replacement?
Your doctor should explain the risks of the procedure specific to you. Risks depend on your shoulder anatomy, your age, your overall health status, the expertise of your surgeon and the surgical team he or she works with, and patient care after surgery.
General risks of surgery
The general risks of surgery include:
Adverse reaction to anesthesia, such as difficulty breathing
Excessive bleeding, which can lead to shock
Surgical site infection, such as methicillin-resistant Staphylococcus aureas (MRSA)
Potential complications of reverse total shoulder replacement
Many of these procedures are successful, but potential complications include:
Arthritis development in the joint months or years after the procedure
Damage to the nerves, muscles, tendons or blood vessels
Fracture of the humerus or scapula during or after surgery
Misalignment or loosening of the prosthetic joint
Reducing your risk of complications
You can reduce your risk of certain complications by:
Closely following the guidelines provided regarding pre- and postoperative activity, diet and lifestyle recommendations
Following through with physical therapy
Promptly notifying your care team of any post-discharge fevers, bleeding, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have allergies or breathing problems, or if you’ve had a bad reaction to an anesthetic in the past
How do I prepare for reverse total shoulder replacement surgery?
You can take steps to improve your chances of successful shoulder surgery. Prepare for the procedure by:
Bringing a button shirt to the hospital. It will not be possible to pull on a shirt over your head to go home in. Have extras at home too.
Enlisting help at home for the first several weeks after surgery. Your arm mobility will be limited during the recovery phase, and you will need someone to help you bathe, dress and perform other normal activities of daily living. You may also need someone else to drive for you.
Preparing your home environment by moving commonly used objects like a coffee cup or toothbrush to a place where you can reach them easily. Remember your arm mobility will be limited due to the arm sling you’ll be wearing.
Stopping certain medications in advance of surgery if necessary — as your doctor recommends. These might include certain anti-inflammatory medicines for pain and arthritis, blood thinners, and other drugs.
Questions to ask your doctor
Before undergoing reverse total shoulder replacement, be sure to ask:
Do I need medical clearance from another doctor, such as a cardiologist?
How often do your patients encounter complications from the surgery or the prosthetic shoulder joint? What do you do to correct them if they occur?
How can I reduce my risk of postsurgical complications?
How will my pain be controlled?
Which of my current medications, vitamins, and other supplements can I continue taking, and which ones do I need to stop taking?
Will I have a postsurgical drain to maintain? Who will instruct me about that? When will the drain be removed?
How do I contact you after hours? Ask for numbers to call in case of concerns.
What can I expect after reverse total shoulder replacement?
Having shoulder replacement surgery requires advance planning for a successful recovery. You should think about how you will perform common activities while wearing an arm sling, especially if the surgery will affect your dominant side.
What will my activity limitations be?
Your arm will be in a sling for several weeks, except when you’re performing physical therapy exercises. You will not be able to reach above your head or move your hand far from your body. To understand how you will need to set up your home environment for recovery, try tucking your hand in the waistband of your pants while going through your daily routine, then make adjustments accordingly by placing common objects in easy reach or finding out which tasks, like showering, you may not be able to accomplish on your own at all. Also consider your sleeping arrangements. You may want to put extra pillows on the bed to help support your arm or make turning easier.
How long will it take to recover?
The overall process of reverse shoulder replacement rehabilitation takes quite some time. You will recover in the hospital for one or two days, depending on your general health status. After that, you may be discharged home or to a rehabilitation hospital if you do not have anyone available to care for you at home the first few weeks. You will need to adhere to a program of physical therapy over the course of several weeks. The goal of reverse shoulder replacement rehabilitation is to restore strength and mobility to the joint.
Will I feel pain?
The incision may feel uncomfortable for a few days after surgery, and you may experience discomfort in the shoulder joint after surgery. Your doctor will follow a pain protocol to minimize your discomfort as safely as possible. Physical therapy is also uncomfortable, which is normal. If you experience severe pain after surgery, talk with your doctor about pain management.
When should I call my doctor?
Most patients schedule their first postsurgical follow-up appointment in advance of the procedure. But, you also should call your doctor if you experience any of these signs or symptoms:
Change in mental status, such as delirium or loss of consciousness
Falls, even if you don’t fall on the new shoulder
Fever higher than 101 degrees Fahrenheit
Dark reddening and heat over the incision area, which can indicate infection
Pain that progressively gets worse instead of better
Sudden difficulty breathing, which can indicate a blood clot in the lung
How might reverse total shoulder replacement affect my everyday life?
As you progress through physical therapy, you may find that your arthritic shoulder pain has greatly improved or gone away, and you may experience a much better range of motion and strength in your arm. These improvements might help you accomplish more activities of daily living than you were able to perform before surgery. With reduced pain and increased function, you will likely enjoy a better overall quality of life too!