January 27th, 2011
I often get questions about reverse total shoulder replacement surgery. To help patients understand this surgical approach, I thought you might like to read my thoughts on this form of treatment.
In a healthy shoulder, the rounded end of the humerus, or upper arm bone, fits into a socket on the scapula, or shoulder blade. This creates a ball-and-socket joint that allows the arm to be lifted, bent, and rotatated. It also permits the arm to be moved laterally as well as forward and back. The tendons and muscles of the rotator cuff provide stability for the joint, counteracting the deltoid muscle, which tends to pull the humerus upward.
Patients who have a severe rotator cuff tear as well as arthritis in the shoulder may be candidates for reverse total shoulder replacement surgery. Those who have undergone a traditional shoulder replacement that failed may also be helped by the procedure. Candidates are normally experiencing severe pain, decreased mobility, and instability in the shoulder joint.
A reverse total shoulder replacement is the surgical removal of the diseased joint and the insertion of a prosthetic joint. It is called a reverse procedure because it reverses the body’s anatomy. Instead of locating the ball on the end of the humerus, it is on the scapula, while the replacement socket is attached to the humerus. This arrangement allows the deltoid muscle to assume much of the work required to lift and stabilize the shoulder.
The operation normally is about two hours long and usually takes place in the hospital under general anesthesia. A nerve block can also be used if the surgeon and patient deem it preferable. Most patients will remain as inpatients for two days after surgery. Extensive physical therapy is normally required, but patients may have their activities limited for the first few weeks. Driving is not recommended for the first five or six weeks, lifting should be avoided, and the arm may be placed in a sling around the clock for a time. Reverse total shoulder replacement surgery will not allow the patient to play contact sports or work at jobs that require heavy lifting. It is seldom performed on patients whose rotator cuffs are intact.
Once surgery is complete, the patient will be transferred to the recovery room, normally for one or two hours. Occasionally a tube is placed to drain fluid from the area of the incision. The drainage tube is typically left in place until the day after surgery. Once pain is controlled, the patient can be discharged home. However, he pr she may need to arrange in-home care and physical therapy to assist with routine activities for a week or two. The surgeon will establish an exercise routine that the patient should follow faithfully after discharge.
After surgery, the patient may be given pain medications orally or intravenously. Each patient requires a different level of pain medication, and some patients experience little need for analgesics. Pain medication is usually not required after the first two weeks except for therapy in cases where the shoulder tightens up or scars.
I hope this helps further explain a total reverse shoulder replacement surgery!
Until next time,
|About the Author: Dr. Stuart Gold, M.D. is a board certified orthopedic surgeon who has 23 years experience specializing in sport injuries, joint replacement, arthritis and limb salvage. As the Director of the Orthopedic Institute, Dr. Gold recently published The Patient's Guide To Orthopedic Surgery to help patients better understand the challenges, risks and opportunities of orthopedic care.|