Reverse Shoulder Replacement Surgery – Everything You Must Know
For people who suffer from arthritis, shoulder pain can make daily tasks extremely difficult. That’s where reverse shoulder replacement surgery comes in.
Recommended for patients with a torn rotator cuff or cuff tear arthropathy, reverse shoulder replacement replaces these muscles. It uses the deltoid muscle to facilitate your arm’s motion. It reverses your body’s natural anatomy by fitting a metal ball into the shoulder socket and a plastic cup to the upper arm bone.
Read on to find out how the process works, who can benefit from it, and why it’s better for certain medical conditions than traditional shoulder replacement.
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How is Reverse Shoulder Replacement Different From Traditional Shoulder Replacement?
Put simply, reverse shoulder replacement is the exact opposite of the traditional procedure. But before we can get into how this works and who it can benefit, you need to understand how your joints and muscles work.
The humerus is the long bone between your shoulder and elbow joints. It is connected to several muscles that help move your arm and give you a complete range of motion. These include the pectoralis major, latissimus dorsi, deltoid, and rotator cuff.
The rotator cuff muscles connect the scapula to the humerus. These four muscles stabilize the shoulder and allow rotation at the shoulder joint. Meanwhile, the deltoid muscle helps move your arm forward, backward, and sideways.
In a traditional shoulder replacement process, the focus is on repairing the anatomical damage caused by missing cartilage. Think of the shoulder joint as a ball and socket joint with the head of the humerus as the ball and the flat shoulder blade as the socket.
Normally, the ball is replaced by a metal ball and the socket with a piece of plastic. In short, the regular system is replaced.
However, for people with cuff tear arthropathy, chronic shoulder dislocation, or a completely torn rotator cuff, this simply won’t work. In fact, it would make them further immobile and cause a lot of pain. That is why a reverse total shoulder replacement is a better option.
In this reverse procedure, the metal ball is fixed to the shoulder socket and supported using a metal stem attached to the humeral head. This pushes the strain of arm rotation and mobility on the deltoid muscle instead. In fact, studies also show that reverse prosthesis has an 85 to 90 percent success rate in terms of pain relief.
What Causes Damage to The Rotator Cuff?
If you have a massive rotator cuff tear, it can be because of injury or degeneration. The most common cause of rotator cuff tears is accidents where you break your fall with an outstretched hand. The angle of the fall and the resulting pressure exerted on the shoulder joint can cause a large tear with severe pain.
Another cause is slow degeneration. This is often the case for older patients or people whose jobs are labor-intensive. Repeated stresses over a long period can slowly worsen a tear until it requires reverse replacement. That said, this is an elective surgical procedure, so it is up to you to decide whether you want to undergo the process.
Who Needs Reverse Shoulder Replacement Surgery?
An orthopedic surgeon will recommend reverse total shoulder if a patient has:
- a severely torn rotator cuff that is beyond repair
- cuff tear arthropathy and shoulder arthritis
- a failed previous shoulder replacement
- limited shoulder function with severe pain
- a fractured shoulder joint
- a tumor in the joint
- a history of failed alternate treatments like physical therapy, cortisone shots, etc
If you have joint or tissue damage, you may notice symptoms like
- pain during daily activities like bathing
- muscle stiffness when you raise your arm over your head
- stiffness and pain that makes it difficult to sleep
- recurring pain despite undergoing other treatment plans like physical therapy, steroid use, or NSAIDs (anti-inflammatory drugs)
Generally, patients who require reverse shoulder replacement surgery have a history of medical treatments like arthroscopic shoulder surgery. This is often the last resort in terms of pain management and arm mobility.
Can You Get Reverse Shoulder Replacements?
There are several factors that may make you ineligible for reverse shoulder replacement. These include:
1. Nicotine Use
People who smoke cigarettes, pipes, and cigars or use vaping devices have higher rates of post-surgical complications. As such, patients who use nicotine daily are encouraged to reduce or minimize their intake before surgery drastically. Otherwise, the risk of post-op infection may prevent an orthopedic surgeon from suggesting this treatment plan.
2. Prior Infections
Similarly, if a patient has a prior infection, doctors will not recommend a reverse shoulder replacement until the infection is cleared. This can include systemic infections or skin conditions that increase the likelihood of post-op complications.
3. Deltoid or Nerve damage
If a patient’s deltoid muscle or the nerves connecting the shoulder to the spinal cord are damaged, it is not possible to rehabilitate a shoulder replacement.
What Benefits Does A Reverse Shoulder Replacement Offer?
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Reverse shoulder replacement surgery can offer patients multiple benefits in terms of mobility and pain relief. Studies show that around 85 to 90 percent of patients experienced significant pain relief after the surgery. Success rates were higher in first-time patients than in repeat cases because of scar formation and muscle damage.
Reverse shoulder replacement may also increase ease of movement to varying levels. Most patients record being able to raise their hands above their heads, while some are able to stretch out their arms sideways. This type of external rotation is not possible in cases where the rotator cuff is entirely torn.
Additionally, the research to date shows that successful surgeries last up to 15 years.
Are There Any Potential Complications?
Like with all surgeries, there is some potential for post-op complications. One issue is the likelihood of the prosthesis being dislocated. Although this is rare it is possible to dislocate a reverse total shoulder replacement
This happens when the humerus (arm section) pulls out of the metal ball (shoulder blade) so both sections separate. A simple solution is to rejoin the prosthesis and rest the arm for a while, although in some cases, additional surgery is necessary to tighten the arrangement.
Another risk is that of post-op infection, although surgeons are very careful to prevent this. If the prosthesis is infected, the doctor will use an antibiotic wash or other treatments to treat it.
What Can You Expect When Undergoing Reverse Shoulder Replacement?
In case it is revision surgery, the first stage involves removing the previous shoulder replacement. However, if it is a first-time replacement, the surgeon will start by administering general anesthesia. Overall, the surgical process requires 2 to 3 hours, followed by postoperative care. Pain medication can be administered orally or injected. Most patients will be able to move their fingers, wrist, and elbow by the following day.
Once the prosthesis is placed, the bone will need time to heal before the patient can regain shoulder motion. This can take a few weeks. A blood transfusion may occasionally be required as part of the healing process. The specifics vary from case to case.
Summary
A reverse shoulder replacement is necessary if the muscles and tendons connected to the shoulder joint are torn beyond repair. It can help patients gain shoulder mobility and drastically reduce chronic pain conditions. This procedure has a high success rate and is the best solution for patients with torn rotator cuffs, cuff tear arthropathy, or shoulder arthritis.
References
https://orthoinfo.aaos.org/en/treatment/reverse-total-shoulder-replacement/
https://orthop.washington.edu/patient-care/articles/shoulder/reverse-shoulder-replacement.html