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Reverse Shoulder Replacement

Total shoulder replacement is a very successful procedure to reduce pain and restore mobility in patients with end-stage shoulder arthritis or after a severe shoulder fracture.

Shoulder replacement surgery relieves pain, improves motion, and restores strength and function to the shoulder. By one year from surgery the vast majority of patients have returned to playing golf or tennis, swimming, doing yoga, yardwork, or even lifting weights.

What is Reverse shoulder replacement surgery?

A reverse shoulder replacement is similar to a standard total shoulder replacement in that we replace the arthritic ball and socket of the shoulder with metal and plastic replacement parts.  But a standard shoulder replacement only works well when your rotator cuff is normal.  If your rotator cuff is torn, a regular shoulder replacement won’t work well, leaving you with pain and weakness. 

The reverse shoulder replacement is specially designed for patients who have both arthritis and a rotator cuff tear.  A reverse shoulder replacement can also be performed for people with large rotator cuff tears that cannot be repaired.  A reverse shoulder replacement gets rid of the pain from arthritis and also restores the strength and motion lost due to the rotator cuff tear.

How is a Reverse different from a standard shoulder replacement?

This could more accurately be called an “inverse” shoulder replacement.  Most of the steps of this surgery are the same, however the implants reverse the position of the ball and socket.  After removing the arthritic surface of the bones, ball is placed on top of the old socket and a socket is placed where the old ball of the joint was.

This changes the leverage and pivot points in the shoulder to allow the remaining muscles to lift the arm without the rotator cuff.

Who is a candidate for a reverse shoulder replacement?

The ideal patient for a reverse shoulder replacement is:

Some patients who are over 75 may be candidates as well because of concerns over the ability of their rotator cuff to heal properly after a standard shoulder replacement.  Certain patients with severe shoulder fractures may also benefit from a reverse shoulder replacement.  Patients that require the use of a walker or other device to walk may decide to go with the reverse instead of a total because it allows them to bear weight immediately after surgery.  That allows them to use the walker and get around immediately after surgery instead of being stuck in a sling.

Who performs shoulder replacements?

Sports Medicine specialists are often specially trained at both standard and reverse shoulder replacements.  At Bone and Joint Specialists of Winchester, Dr. James Larson and Dr. Steven Pancio perform total shoulder replacements and reverse shoulder replacements.

Diagnosing shoulder arthritis

The basic diagnosis of shoulder arthritis is made with plain X-Rays.  If you’ve had X-Rays at an outside facility, our physicians may request that you get new ones in our office.  This is usually because specific angles are required to see the shoulder joint clearly, and other offices my not have obtained these specialized views of the shoulder.  We may also need radiographs on our own system in order to properly plan for surgery.

Sometimes we may also order an MRI to check for rotator cuff tears.  If you have both arthritis and a cuff tear, you will often have better results with a reverse shoulder replacement instead of a standard shoulder replacement.  A CT scan may be ordered so that we can plan for any bone loss or create patient-specific guides for your surgery.

Can shoulder replacements be performed as an outpatient?

Yes, both standard and reverse shoulder replacements can be performed as an outpatient.  This is the result of decades of refinement to surgical techniques and improvements to anesthesia.  These have greatly reduced the risks of bleeding and other complications, allowing you to have your surgery and safely go home with friends or family the same day.  The decision to have shoulder replacement as an outpatient will be made between you and your surgeon and depends on your other medical conditions as well as home support.

What are other options to shoulder replacement?

We always reserve surgery for when other options have failed to relive the pain of arthritis.  Other treatments for shoulder arthritis include

How is shoulder replacement performed?

In reverse shoulder replacement surgery, the damaged humeral head (the ball of the joint) is replaced with a metal tray and plastic socket while the glenoid cavity (the joint socket) is implanted with a metallic base plate and screws that hold a metal ball

Anesthesia for reverse shoulder replacement surgery

During a total shoulder replacement, the patient will usually have both regional anesthesia and general anesthesia. Regional anesthesia is usually performed by administration of a nerve block to the shoulder.  This results in the entire arm being numb during the surgery.  That means you need less anesthesia and narcotic medications during surgery.  And that helps prevent nausea, vomiting, grogginess, and other side effects of the anesthesia.

How long does a reverse shoulder replacement take?

While an uncomplicated shoulder replacement usually takes less than an hour, it can take up to a couple of hours in some cases.  If you have severe arthritis, osteoporosis, large bone spurs, loss of bone, or severe contractures of the joint, surgery may be longer than usual so that these problems can be properly addressed. 

What are the risks of a reverse shoulder replacement?

Complications are rare in total shoulder replacement.  In general, there is less than 2% risk of major complications.  But these can include:

*An arthritic shoulder is often very tight prior to surgery. Physical therapy after surgery is usually needed to restore motion back to normal.  Continuous physical therapy efforts are usually effective in restoring shoulder motion and strength.

How long does it take to recover from a reverse shoulder replacement?

After a reverse shoulder replacement, you are allowed to start using the shoulder as quickly as pain allows.  You can even use the arm to support your weight on a walker or cane the day after surgery.

Time-lime for recovery after shoulder replacement

Returning to work

The exact time a person can return to work depends greatly on the motion and strength of the shoulder and how the patient is progressing.  But it usually takes two to three weeks to return to desk though don’t expect to type with the surgical arm.  Four months or more of recovery is required for heavier, physical labor.

In all cases, proper and extensive postoperative rehabilitation are key factors in achieving the maximum benefit of shoulder replacement surgery.

Surgeons Treating Frozen Shoulder

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