Reverse Shoulder Replacement Surgery (Arthroplasty)
Replacing Your Worn Shoulder
Arthritis of the shoulder can develop over a period of time leading to symptoms of stiffness, pain, weakness, and loss of function. When conservative treatment methods such as medications, physical therapy, and injections fail to provide significant relief, there are surgical options. The most likely option to help over the long term involves that of a shoulder replacement.
The shoulder joint is somewhat similar to the hip joint in that it is a ball and socket joint with the ball on the arm side of the joint and the socket on the chest side of the joint. However, the shoulder is required to move through a much greater range of motion than the hip in order to allow us to place the arm in the desired positions for normal function. Therefore, while the hip is a somewhat deep socket with stability achieved by the ball sitting within an enclosed socket, the shoulder is a very shallow socket that requires stability from the balance of the muscles around the shoulder.
Shoulder replacement surgery almost always relieves pain and may give you more strength and movement in your shoulder and may let you return to many of your normal activities. It is not known for exactly how long a prosthesis will last, but it can last many years. This depends on many factors including your health, activity level, quality of the bone, the nature of the disease, and how well the implants adhere to the bone.
Surgery With A Reverse Prosthesis
This is for patients with shoulder arthritis and a massive irreparable rotator cuff tear. The designation of “Reverse” is due to the usual position of the ball on the arm bone and the socket on the scapula being reversed so that the ball is on the scapula and the socket is on the arm bone. Like a hip, knee or total shoulder replacement, surgery involves removing the arthritic surfaces of the shoulder joint and replacing them with a metal ball and plastic lining to allow for smoother, more pain-free motion within the joint.
During surgery an incision about 10cm long is made from your collarbone to the middle of your arm. The humeral head is removed and the stem is cemented or press-fit into the bone. The glenoid surface is prepared to accept a metal ball which is then secured. A plastic cup is secured to the humeral stem and the shoulder is reducec. Scarred and contracted muscles also are released to allow (in most cases) an improved range of motion. The primary goal of the surgery, however, is pain relief. Once the new joint is in place, your surgeon closes the incision with sutures (stitches) and or staples.
Postop Precautions
Wear your sling until the surgeon tells you not to. You may take it off for exercises and bathing only. The pillow between you and your sling may be removed at any time.
Do not attempt to move your arm to the side or raise it forward unassisted until instructed to do so. Doing this will overstress your healing muscles.
Do not lean on your arm or support your weight with it.
Hospital stay:
The surgical procedure requires that you stay in the hospital after the surgery for approximately one to two nights, before being discharged home.
Physical Therapy:
You will be started on gentle pendulum exercises with the physical therapist on the first or second day after surgery. Continue these exercises at home on your own or with the assistance of a family member. You will usually attend physical therapy on an outpatient basis to receive ongoing instruction about progression of your exercises. These visits are combined with physician office visits. You will gradually return to normal activities over the first few months after surgery. There is significant variability in the speed at which patients recover, this is due to multiple factors.
Sleeping:
It will probably be easier for you to sleep in a Lazy-Boy type recliner, or in bed with multiple pillows for support for the first couple of days or weeks.
Sling:
Your sling should feel comfortable. For proper positioning, your elbow should be completely in the back corner of the sling and should be bent at or slightly greater than a 90-degree angle. The sling strap should come across your back and over your opposite shoulder. To avoid damage to the nerves in the wrist, your wrist should be inside the sling. To help guard against skin irritation, wear collared shirts or pad the sling strap.
Hand Swelling:
It is common to have hand swelling in your operative arm. This will decrease with time.
Stiffness or Instability:
Postoperative motion varies depending on the amount of destruction and contracture that occurred before surgery. Some joints are more prone to stiffness following surgery, while others are prone to excessive looseness or instability that in some cases can even lead to dislocation and may require further treatment.
Studies have shown that complications are generally lower in centers that perform this procedure on a regular basis. The overall patient satisfaction with this procedure has been very positive.
Activities:
Most patients return to an improved level of function with their daily activities; in some cases, even allowing golf and/or light tennis activities. Heavy weightlifting or heavy labor activities are usually discouraged. This is due to the concern over the prosthesis loosening from the bone over time and thus requiring further surgery.
Antibiotics Before Any Dental Work
You will need to take prophylactic antibiotics before any dental work over the next two years and possibly longer (see: Antibiotic Prophylaxis After Total Joint Replacement handout).