Reverse Total Shoulder Replacement
Shoulder replacement is one of the most recommended surgical procedures for patients who have arthritis or shoulder fractures. However, conventional shoulder replacement surgery is not as effective for patients with complex rotator cuff tears. This is because of an increased risk of pain and limited shoulder motion for the patients.
Dr. Christopher R. Sforzo recommends reverse total shoulder replacement as an alternative for rotator cuff tear and arthritis. Read on for an overview of our procedure, our shoulder replacement protocol, potential complications, and frequently asked questions about the procedure.
What Is a Total Reverse Shoulder Replacement?
It is a surgical procedure involving a reverse of the socket and shoulder ball from their natural position. In the reverse shoulder replacement, the metal ball goes into the socket of the shoulder joint while they attach the plastic cup to the humerus (bone of the upper arm). Dr. Christopher R. Sforzo is board-certified, fellowship-trained, in diagnosing and treating such types of shoulder replacement problems.
When Is a Reverse Shoulder Replacement Needed?
A reverse replacement of the shoulder joints is essential for patients with an extreme tear of the shoulder muscles. This includes cuff tear arthropathy, or where surgery for arthritis or fracture management cannot yield a positive outcome. The rotator cuff normally holds the shoulder in place. If the torn shoulder is unstable a traditional replacement will not work.
In a normal shoulder replacement, the muscles and tendons attach to the shoulder blade to make the shoulder joint intact. But sometimes, the tendons are extremely torn and they can barely attach to the shoulder bone. This causes severe destruction of the shoulder joints and irreparable loss of the rotator function that requires a reverse operation.
In addition, you may require a reverse shoulder surgery if you have the following symptoms:
- A chronic dislocation on your shoulder
- Severe pain on your shoulder or difficulty when you lift your arm above your head
- An unsuccessful shoulder replacement
- A tumor on your shoulder joints
- Failed medications, injections, or physical therapy to relieve shoulder pain
Reverse Shoulder Replacement Protocol
A reverse surgery is like a normal shoulder operation, with only a few differences regardless of the condition, your surgeon will guide you through the process. Below are the basic steps followed by our proficient doctors during the procedure of reverse shoulder replacement:
Medical Evaluation
Dr. Sforzo first medically reviews your physical, mental, and general health. This determines if you are healthy enough for the surgery and able to walk through the recovery process. Chronic conditions such as cardiovascular complications may require review by our specialist.
Medication Review
Before your surgery, Dr. Sforzo will discuss with you any medications you currently take. You may stop using certain medications 2 weeks before the surgery since they may lead to excessive bleeding. They include medication for arthritis, blood thinners, and non-steroidal medications such as ibuprofen and aspirin.
Preoperational Preparation
On the appointed day, you will arrive at the hospital or surgery center. Then, you will be taken to the preoperational room, where you will be advised on the best anesthesia to use. The anesthesiologist will administer general anesthesia, regional, or a combination of both, to reduce pain during the procedure. Regional anesthesia puts just the arm to sleep. The patient then can have very mild anesthesia so they don’t remember but makes the procedure very safe.
Surgical Procedure
During the procedure, our seasoned surgeon makes an incision in front of your shoulder. The surgeon then separates the muscles. This enables the surgeon to remove the damaged part and fix the new components to restore your shoulder mobility.
The replacement parts are fixed solidly to your bones to allow for early motion. The incision is then closed and you are on your way to recovery.
Reverse Shoulder Replacement Surgery Rehabilitation
Rehabilitation and recovery after the surgical operation is a gradual process that may last a few months before you have complete comfort and regain full muscle function. Upon discharge from the hospital, you will wear a sling on your arm to relieve pressure from the surgical site and promote soft tissue healing.
Although the process is home-based, our doctor may still recommend occasional X-rays and office visits to monitor your healing progress. In addition, our surgeon may recommend simple motion exercises to enhance your shoulder mobility and increase endurance.
Below are common physical therapy exercises that are recommended by our doctors after a reverse total shoulder replacement:
Passive Shoulder Flexion
To begin this exercise, put your hands on top of a chair or bench at waist level. While keeping your arms straight and stepping a little backward, slightly bend until you feel a stretch on your shoulders. Hold this position gently for at least 10 seconds and repeat it five times.
Passive Pendulum
In this workout, you allow your operated arm to fall from your body with your waist bent slightly forward. For better results, aim for an angle of 90 degrees between your arm and body. Try to maintain this position for at least ten seconds and repeat the whole procedure five times.
Posture
This exercise allows you to stretch your shoulders and your back after removing the sling. The workout involves rolling your shoulders gently and squeezing the shoulder blades together for some time. You can hold the position for at least 10 seconds and repeat each procedure at least five times.
Passive External Rotation
In this workout, you bend your elbows at a 90-degree angle while keeping your arms across the front part of your waist. You can then use a stick or the other arm to push the operated arm away from the body until you feel a gentle stretch. Hold this position for at least five seconds and have five repetitions.
Reverse Shoulder Replacement Risk and Complications
Reverse shoulder replacement is a highly technical procedure performed by specialized orthopedic surgeons at Sforzo, Dillingham, Stewart Orthopedics + Sports Medicine. Despite this, significant risks and complications may still occur after the surgery. Here, our surgeon will help you understand the risks or complications before surgery.
You may experience the following complications after a shoulder replacement:
Infection
An infection may occur in the operated area, prompting the removal of the prosthesis. Sometimes our medical practitioners may use antibiotics or surgical cleansers to disinfect the affected area. In rare situations, chronic infection may require further surgery to achieve relief.
Dislocation
A dislocation of the prosthesis can occur if the humerus separates from the ball after the surgery. This means the two parts of the prosthesis become detached from each other, hence require immediate fixing by the surgeon.
Other rare complications include blood clotting on the legs, anesthetic reaction, numbness, tingling sensation, nerve damage, and injury to the blood vessels. Complications do occur but the likelihood of a complication is extremely low.
Reverse Shoulder Replacement Surgery Prevention
You can enhance your health before and after surgery by observing important precautions. This is because, after the surgery, you will wear a sling that will limit your normal arm function.
Simple home adjustments will also come in handy to help you resume a normal life. For instance, you may need help in doing routine activities like bathing, cooking, and laundry. It is only for a few weeks after the surgery, so you shouldn’t worry about it.
Below are major precautions Dr. Sforzo suggests to observe after a surgery:
- In the first six weeks after surgery, avoid arm positions that may put pressure on your operated shoulder. An example is when you stretch your arm to the side of your body.
- If you can do some strenuous activities, do not overdo to extremity
- Ensure you follow the physical therapy program prescribed by your doctor
- During the first six weeks after your surgery, do not lift a load weighing over five pounds
- Do not use your arm for support when rising from the bed or chair, as it may contract your shoulder muscles
Reverse shoulder replacement therapy is one of the most effective procedures to help patients find relief from chronic shoulder pain. With an 80%-90% success rate, its benefits cannot be overemphasized. If you have persistent chronic pain in your shoulder joints, consult our doctor, Dr. Christopher R. Sforzo for advice on reverse shoulder replacement.
