Reverse Total Shoulder Replacement
A reverse total shoulder replacement is performed when you have experienced a complete tear of the rotator cuff, arthritis of the shoulder, or an unsuccessful total shoulder replacement. Your surgeon at South Florida Orthopaedics & Sports Medicine will begin by exploring any nonsurgical treatment options such as physical therapy and anti-inflammatory medication to reduce the pain and allow the shoulder to heal. If conservative methods are unsuccessful, a reverse total shoulder replacement may be proposed.
This procedure is extremely effective at reducing the pain in the shoulder and reestablishing shoulder mobility in a majority of cases. While it is difficult to recover from a complete rotator cuff tear, your surgeon at South Florida Orthopaedics & Sports Medicine will help you make the decision if a reverse total shoulder replacement is right for you.
A majority of patients regain range of motion and experience a significant reduction in pain following a reverse total shoulder replacement.
The most common conditions that require a reverse total shoulder replacement are a completely torn rotator cuff, an unsuccessful total shoulder replacement, and arthritis of the shoulder. The rotator cuff is the group of tendons and muscles that hold the shoulder joint in place and allow the shoulder to move. The shoulder is made of a ball-and-socket structure with the humeral head (the ball at the top of the arm bone) and the glenoid (socket in the shoulder). In a reverse total shoulder replacement, the roles are reversed and a socket is created in the place of the humeral head and a ball is created in the glenoid.
Your surgeon will make an incision in the upper arm to access the damaged tendons and bones. The humeral head is removed and the top of the humerus (arm bone) is partially hollowed to allow a metal socket to be inserted into the arm. The glenoid (shoulder socket) is reshaped and a prosthetic ball component is put in place. A plastic socket cup is added to the new humeral head to allow for smooth movement in the new shoulder. The deltoid muscle at the top of the shoulder is now responsible for the movement of the joint while the damaged rotator cuff is relieved of pressure.
A reverse total shoulder replacement has the potential to alleviate the pressure from a damaged rotator cuff and correct any damages caused by an unsuccessful traditional total shoulder replacement. Improved mobility and a significant decrease in pain occur in a majority of patients.
Traditional vs. Reverse Total Shoulder Replacement Surgery
In a traditional total shoulder replacement, the top of the humerus (arm bone) and the shoulder socket are removed and replaced with metal hardware to rebuild the shoulder. This method maintains the traditional ball-and-socket structure in their natural positions. A traditional total shoulder replacement is most effective when damage occurs in the shoulder joint, not in the surrounding muscles.
A reverse total shoulder replacement switches the functions of the shoulder through metal prosthetics. The top of the humerus is replaced with a socket and a rotator ball replaces the shoulder socket allowing the deltoid muscle to become responsible for supporting the shoulder.
Recovery and Results of a Reverse Total Shoulder Replacement
Following surgery, your arm will be placed in a sling. You will need to stay in the hospital for two to three days while your physical therapist will begin teaching you movement exercises to help with recovery. During the first few weeks of recovery, you may need assistance dressing, bathing, and performing other normal, light activities. However, within two to three weeks, you will be able to remove the sling and begin resuming normal personal actions without help.
Physical therapy is a necessary component of the recovery process. Your treatment plan will be individualized to meet your recovery needs. In some cases, you may be able to complete your physical therapy at home with the instruction of your therapist. Functions such as reaching above the head may require extra healing time and will improve as physical therapy progresses. Typically, patients can expect to make a full recover four to six months following surgery.