Reverse Total Shoulder Replacement
A reverse total shoulder replacement is a surgery that may be performed for patients with rotator cuff arthropathy. It involves resurfacing the end of the shoulder bone (humerus) and socket (glenoid) with artificial components. Metal implants are sized and fixated onto the ends of the bones, and a specialized plastic bearing is placed between the metal components. These new components glide smoothly against each other, which alleviates pain and leads to improved range of motion, function, and quality of life.
Why shoulder arthroplasty
A reverse shoulder arthroplasty is a special type of shoulder replacement that is performed when patients have no functioning rotator cuff. This can occur in certain types of large tears or when patients have failed previous rotator cuff repair. This type of replacement can also be used for certain types of fractures of the upper arm bone (i.e. proximal humerus fractures).
A reverse shoulder replacement differs from traditional shoulder replacement in the following way. In a traditional or anatomic shoulder replacement, the ball at the top of the upper arm (the humeral head) is replaced with an artificial ball that is placed onto a stem inserted in the upper arm, and the socket is resurfaced with a piece of plastic. However, with a reverse shoulder replacement, the opposite occurs. The ball is placed on the socket side and is attached to a baseplate secured to the socket with screws. A specialized plastic that looks like a socket and metal tray are attached to a metal stem inserted into the upper arm bone.
With the reverse orientation of the components, the arm is effectively lengthened. This makes the deltoid muscle of the shoulder more efficient at lifting the arm, providing a way for the body to raise the arm up and out to the side without a rotator cuff.
An incision is made (about 8 cm) in the front of the shoulder. Dr. Faulkner and his assistant will identify many anatomic structures and will place retractors that help protect those structures and allow for visualization. In order to enter the shoulder joint, a muscle called the subscapularis is released from its attachment to the top of the humerus. The humeral head (ball) and glenoid (socket) are identified and reconstructed based on the 3D blueprint that was obtained prior to surgery. Dr. Faulkner will then trial different sizes of the new components to evaluate the best anatomic fit for the patient, and the new components will be fixated to the bone. Dr. Faulkner and his assistant will repair the subscapularis muscle and close the incision. Dressings will be placed over the incision, and the patient will wake up in a sling.
- This surgery is performed under general anesthesia with a nerve block.
- This surgery is usually inpatient, which means the patient generally stays the night at the hospital to allow for nurses to closely monitor the patient. Healthier patients may be able to have an outpatient procedure and return home the same day.
- Surgery typically lasts 1.5-2 hours.
- Patient will be fit for a sling at a preop appointment before surgery and will need to bring this to surgery.
- The sling will be placed on the patient prior to waking up from anesthesia.
- The incisions will be closed with absorbable sutures and a waterproof dressing will be applied. This should be left in place until the first postop appointment.
- The patient may shower right away as long as there is a good seal of the waterproof dressing.
Why Shoulder Arthroplasty for Rotator Cuff Arthropathy
- Decrease pain
- Regain shoulder range of motion and strength
- Allow patients to perform activities of daily living such as bathing and reaching into cabinets with minimal pain
- Return to activities with improved function
- Patients who fail conservative treatment including physical therapy, pain medication, activity modifications, and injections
- Patients who have a decreased quality of life due to their shoulder function
- Patients who want to reclaim their shoulder function
- Typically patients are over 60 years old
Recovery following a reverse total shoulder arthroplasty is generally 6-12 months. Patients will be placed in a sling for 6 weeks after surgery. They are limited to elbow range of motion and pendulum exercises for this period of time. Physical therapy (PT) will start about 4 weeks after surgery and will last for 3-4 months, depending on a patient’s progress. Physical therapists follow a prescribed protocol outlined by Dr. Faulkner to regain range of motion and strength. Physical therapy and home exercises are a critical part of a patient’s outcomes and quality of life after surgery. The patient should expect to continue to improve with range of motion and strength up to 2 years after surgery, with most of the gains occurring within the first few months after surgery. The patient should plan on being seen in clinic about every 6 weeks for 6 months after the surgery for close monitoring and to ensure any questions are answered. Follow-up appointments with x-rays are recommended at 1 year postop and every 2 years subsequently to ensure there is no evidence of loosening or shifting of the components.
In May of 2019 Dr. Faulkner performed a total reverse shoulder replacement on my right shoulder. Every step from initial MRI, through CT scan, surgery, and physical therapy was handled with clear professionalism, patience, and good humor. Options were clearly stated, questions were answered in non and pro medical speak, and sometimes repeated with no impatience. Dr. Faulkner and his entire team greeted you with genuine good humor and care. The shoulder, a year out is, 95% and improving. Thank you, Dr. Faulkner, for everything.
reverse total shoulder replacement
6 weeks. The sling should be removed at least 3x/day for elbow, wrist, and finger range of motion exercises as will be instructed.
No. Driving with a sling is considered driving impaired and could be subject to a citation.
Yes. Patients are usually unaware of their arm movements at night. The sling helps to ensure that the arm stays in a good position for healing.
Physical therapy typically starts 4 weeks after surgery.
2 days after surgery. You will have a waterproof dressing on that should be left in place until your first postoperative appointment.
The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.
An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.
This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, you may be encouraged to take anti-inflammatories and Tylenol instead of the narcotics.
The overall risk of a complication is less than 1%. The most common risk is shoulder stiffness from scarring. Other more rare risks include infection, fracture, dislocation, and scapular notching.