Overview
Since the 1980s, reverse shoulder replacements have been proven to help millions of patients around the world. In the U.S., thousands of patients suffering from shoulder arthritis successfully receive total shoulder replacements, every year. Reverse Shoulder Replacement is a highly technical procedure, successfully performed on patients who have a complex type of shoulder arthritis called cuff tear arthropathy due to large rotator cuff tears.
During a conventional shoulder replacement, a plastic cup is fitted into the shoulder socket or glenoid and a metal ball is attached to the top of the upper arm bone or humerus. In a reverse shoulder replacement, the socket and metal ball are switched. The metal ball is fitted into the glenoid and the plastic cup is attached to the top of the humerus. This switch helps patients with cuff tear arthropathy because different muscles are recruited to produce movement of the arm.
In a healthy shoulder, the rotator cuff muscles help power the arm’s range of motion. Conventional shoulder replacement also uses the rotator cuff muscles to help position and power the motion of the arm. Rotator cuff muscles in patients with cuff tear arthropathy no longer function; with reverse shoulder replacement, the deltoid muscle is relied on for positioning and powering the arm, not the rotator cuff. Essentially, it replaces and recreates the function that the rotator cuff once did.
Healthy Shoulder
In a healthy shoulder, the ball of the humerus is held in the shoulder socket by several muscles and tendons, including the rotator cuff tendons.
Surgery Candidate
Dr. Stowell will determine if reverse shoulder replacement is the best treatment for you. If other nonsurgical treatments have been exhausted, reverse shoulder replacement may be recommended if you have:
- Cuff tear arthropathy
- An irreparable completely torn rotator cuff
- A failed previous shoulder replacement
- Severe shoulder pain
- A complex shoulder joint fracture
- Chronic shoulder dislocation
- Tumor of the shoulder joint
Preparing for Your Surgery
Dr. Stowell will help you plan and prepare for your reverse shoulder replacement. Most patients must have a physical examination before surgery, usually completed with your primary care physician to ensure that you are healthy enough to have the surgery and to recover from it. Patients with chronic medical conditions, like heart disease, must also be evaluated by a specialist, such as a cardiologist, before surgery. Dr. Stowell must know about all the medications you are currently taking because he may advise that specific ones be stopped before surgery. Some arthritis and non-steroidal anti-inflammatory medications like ibuprofen and aspirin may cause excessive bleeding. Blood thinners will also need to be stopped before surgery for a period of time.
Your recovery can be much easier if you prepare your home in advance. It will be challenging to reach high shelves and cupboards for the first few weeks after surgery. Place items you need often on lower shelves. You may need assistance with daily tasks once you come home from surgery, such as dressing, bathing, cooking, and laundry.
Day of Surgery
Wear loose-fitting clothes the day of surgery. You will be wearing a sling during your recovery, so wearing a button-front shirt will make it easier for you to transition your arm in and out more conveniently.
Once you arrive at the hospital, you will be admitted and taken to the preoperative preparation area where you will meet your anesthesiologist. During your procedure, you may be provided with a general anesthetic, a regional anesthetic, or a combination of both. You, Dr. Stowell, and your anesthesiologist will discuss the type of anesthesia to be used for your procedure.
Your reverse shoulder replacement usually takes about 1 hour to complete.
Recovery
After surgery, you will receive antibiotics to reduce your risk of infection and pain medication to relieve discomfort. You may be an outpatient candidate, where you can go home the day of surgery to begin your recovery or you may be admitted to the hospital overnight. Dr. Stowell will discuss with you the most appropriate discharge process for your recovery after surgery.
After surgery, you will experience some pain, which is part of the healing process. Dr. Stowell may prescribe short-term pain medications to help relieve your pain after surgery.
You arm will be in a sling when you leave the hospital and as you recover. Dr. Stowell will instruct you on your rehabilitation, starting with a gentle range of motion exercises at home to increase your endurance and mobility. Physical therapy may also be recommended by Dr. Stowell to further strengthen your shoulder and increase flexibility.
After a few days post-surgery, you will be able to eat, dress, and groom yourself more independently. Reverse shoulder replacement studies have shown that patients claim outstanding pain relief with very high patient satisfaction.