Reverse shoulder replacement

Dealing with significant shoulder pain and loss of function can dramatically impact your quality of life. Simple tasks like reaching into a cupboard, combing your hair, or getting dressed can become difficult and painful. If you’re experiencing these challenges, particularly due to complex shoulder problems like a severe rotator cuff tear combined with arthritis, a reverse shoulder replacement might be a solution worth exploring.

This procedure, also known as reverse total shoulder replacement or reverse shoulder arthroplasty (RSA), is a specialized type of shoulder surgery designed for specific conditions where a traditional shoulder replacement wouldn’t be effective. Let’s delve into what this surgery involves, who it’s best suited for, and what you can expect during the process.

When is Reverse Shoulder Replacement Recommended?

Unlike a conventional total shoulder replacement, which mimics the natural anatomy of the shoulder, a reverse shoulder replacement is typically reserved for individuals facing specific complex shoulder issues. Your orthopaedic surgeon might recommend this procedure if you have:

Cuff Tear Arthropathy: This is the most common reason for a reverse total shoulder replacement. It describes a situation where you have both a severely torn, irreparable rotator cuff and shoulder arthritis. The rotator cuff muscles are crucial for lifting and rotating your arm and stabilizing the shoulder joint. Without a functioning rotator cuff, a standard replacement often fails because the muscles can’t support or move the artificial joint properly.
Complex Shoulder Fractures: Severe fractures of the upper arm bone (humerus) near the shoulder joint, particularly in older adults with weaker bone quality, can be challenging to repair. A reverse shoulder replacement can sometimes offer a more reliable solution for restoring function.
Failed Previous Shoulder Replacement: If a previous conventional shoulder replacement has failed, often due to rotator cuff issues or instability that developed later, a revision surgery using a reverse shoulder replacement might be necessary.
Chronic Shoulder Dislocation: In some cases of persistent shoulder instability and dislocation, especially when associated with rotator cuff problems or bone loss, this procedure may be considered.
Severe Shoulder Pain and Difficulty Lifting the Arm: If conservative treatments like medication, injections, and physical therapy haven’t provided relief, and you struggle to lift your arm away from your side or overhead due to rotator cuff failure and arthritis, a reverse shoulder replacement could be an option.

The key factor is often the poor function or irreparable damage of the rotator cuff muscles, combined with arthritis or other significant joint problems.

How Does a Reverse Shoulder Replacement Work?

The “reverse” in the name refers to how the artificial components are positioned compared to your natural anatomy and a traditional replacement.

Natural Shoulder: Your shoulder is a ball-and-socket joint. The “ball” is the top of your upper arm bone (humerus), and the “socket” is part of your shoulder blade (scapula), called the glenoid.
Traditional Replacement: This surgery replaces the natural ball with a metal ball and the natural socket with a plastic socket, mimicking the original setup. It relies on healthy rotator cuff muscles to function correctly.
Reverse Shoulder Replacement: This procedure reverses the orientation.
- A metal ball component is attached to the scapula (where the natural socket was).
- A plastic socket component with a stem is fitted into the humerus (where the natural ball was).

Why reverse the design? This clever configuration changes the mechanics of the shoulder joint. Instead of relying on the damaged rotator cuff muscles to power arm movement, the reverse total shoulder replacement utilizes the larger, stronger deltoid muscle (the muscle forming the rounded contour of your shoulder). By altering the joint’s center of rotation, the deltoid muscle can effectively lift and move the arm, even when the rotator cuff is non-functional. This provides pain relief and restores a level of function that wouldn’t be possible with a standard replacement in these specific situations.

What to Expect: The Procedure and Recovery

Understanding the surgical journey and recovery process can help you prepare.

The Surgery:
Reverse shoulder replacement surgery is typically performed under general anesthesia, often combined with a nerve block (an injection to numb the shoulder and arm for post-operative pain relief).

Incision: Your surgeon makes an incision, usually at the front or top of your shoulder.
Removing Damaged Parts: The damaged bone and cartilage from the humeral head (ball) and glenoid (socket) are removed.
Implanting Components: The artificial components – the metal ball on the scapula and the plastic socket/stem in the humerus – are carefully positioned and secured, sometimes using bone cement.
Closure: The tissues are repaired, and the incision is closed with stitches or staples.

Recovery and Rehabilitation:
Recovery is a gradual process requiring commitment to a rehabilitation program.

Hospital Stay: Most patients stay in the hospital for 1-3 days.
Pain Management: Pain is managed with medication, including the initial nerve block and subsequent oral pain relievers. Ice packs also help reduce pain and swelling.
Sling Usage: You will wear a sling for several weeks (typically 3-6) to protect the healing joint. You’ll likely remove it for specific exercises and personal hygiene as instructed by your physical therapist.
Physical Therapy: This is a critical part of recovery. You’ll start with gentle passive range-of-motion exercises (where the therapist moves your arm) soon after surgery. As healing progresses, you’ll move to active assisted and then active exercises to regain movement and eventually strengthen the deltoid muscle and surrounding muscles. Adhering to your physical therapy plan is vital for a good outcome.
Activity Restrictions: You’ll have limitations for several months. Heavy lifting, forceful pushing or pulling, and high-impact activities are typically restricted long-term to protect the implant. Most patients can expect functional movement between chest and waist height, allowing them to perform daily activities more comfortably. Driving is usually permitted once you are out of the sling and have regained sufficient control and comfort, typically around 6-8 weeks post-surgery. Return to work depends on the nature of your job.
Full Recovery: While you’ll notice improvements within weeks, full recovery and achieving maximum function can take six months to a year, or sometimes longer.

Benefits and Risks of Reverse Shoulder Replacement

Like any surgery, reverse total shoulder replacement has potential benefits and risks.

Benefits:

Significant Pain Relief: This is often the primary goal and benefit for patients.
Improved Function: Restores the ability to perform many daily activities, especially lifting the arm to shoulder height.
Solution for Complex Problems: Provides a viable option when rotator cuff damage prevents the success of traditional replacement.
Increased Stability: The design can offer better stability than a conventional replacement in certain situations.

Risks and Potential Complications:

While generally successful, potential complications can occur, including:

Infection: Requires prompt treatment, sometimes involving further surgery.
Dislocation/Instability: The artificial joint components can sometimes dislocate.
Fracture: Bones around the implant (humerus or scapula) can fracture during or after surgery.
Nerve Damage: Nerves near the shoulder joint can be stretched or injured during surgery, potentially causing weakness or numbness.
Component Loosening or Wear: Over time, the artificial parts may loosen from the bone or wear down, potentially requiring revision surgery.
Scapular Notching: The humeral component may rub against the scapula, which can sometimes cause issues over the long term.
Limited Range of Motion: While function improves, the range of motion might not be fully restored compared to a healthy shoulder or a traditional replacement (especially rotation).
General Surgical Risks: Including blood clots, anesthesia complications, and bleeding.

Your surgeon will discuss these risks in detail based on your specific health condition.

Is Reverse Shoulder Replacement Right for You?

If you’re struggling with debilitating shoulder pain and weakness due to conditions like cuff tear arthropathy or a complex fracture, and conservative treatments have failed, a reverse shoulder replacement could significantly improve your quality of life. It offers predictable pain relief and functional improvement for patients who previously had limited options.

The decision to proceed with surgery is personal and should be made after a thorough evaluation and discussion with an experienced orthopaedic surgeon specializing in shoulder procedures. They can assess your specific condition, discuss the potential benefits and risks of reverse shoulder replacement surgery, and help determine if it’s the most appropriate treatment for you.

Take the Next Step:

Don’t let shoulder pain hold you back. If you believe you might be a candidate for reverse shoulder replacement, or wish to discuss your shoulder problems further, we encourage you to seek expert advice.

Book a consultation with Mr. David Shields here: https://www.circlehealthgroup.co.uk/consultants/david-shields

Or contact us for an appointment via email: info@theupperlimbclinic.co.uk

Take control of your shoulder health today.