Reverse Shoulder Replacement

Arthritis and rotator cuff tears are commmon painful condutions of the shoulder joint. Treatments like medications, physical therapy and anti-inflammatory injections work in early phases, but surgical options may be the best way to give long lastign pain relief in later stages of the problem.

Reverse shoulder replacement is a an option for people with severe shoulder pain and dysfunction, who have shoulder arthritis and rotator cuff damage. This is a joint replacemnet procedure which reverses the position of the ball and socket thereby correcting the altered biomechanics of the shoulder due to the dysfunctional rotator cuff.

As a newer pain relieving option for the shoulder joint, Reverse Shoulder Replacement has gained popularity all around the world due to its predictable results and long lasting pain relief.

What is Reverse Shoulder Replacement?

A reverse total shoulder replacement or Reverse shoulder arthroplasty (RSA) is a specialized procedure that can be done for people who have severe pain from rotator cuff injuries and shoulder arthritis. 

The procedure works by replacing the ball and socket joint of your shoulder. In the natural joint of your shoulder, the ball part of the joint is on your arm, and it fits into your shoulder. 

As its name suggests, this surgery reverses how your shoulder joint works. Unlike in your natural shoulder joint, in this surgery, the ball is attached to your shoulder bone, and the socket is attached to your upper arm bone. The principle of this special joint is that you will use the outer, stronger shoulder muscles instead of your rotator cuff to stabilize your new joint. This restores movement in your shoulder joint. This procedure is also done in elderly patients with shoulder fractures, where the rotator cuff attachments to the humerus are badly damaged due to the injury.

Reverse shoulder replacement

Pros and Cons

Although Reverse shoulder replacement is a complicated surgical procedure, it can help people with shoulder pain and difficulty in shoulder movement.

Pros

• The surgery can reduce pain.
• The surgery can improve your range of motion.
• The surgery can improve your quality of life.

Cons

Potential complications of shoulder replacement surgery include:

• Dislocation. It’s possible for the ball of your new joint to come out of the socket.
• Fracture. The humerus bone, the scapula or the glenoid bone can break during or after surgery.
• Implant loosening. Shoulder replacement components are durable, but they may loosen or become worn over time. In some cases, you may need another surgery to replace the loose components.
• Rotator cuff failure. The group of muscles and tendons that surround the shoulder joint (the rotator cuff) occasionally wear out after a partial or total anatomic shoulder replacement.
• Nerve damage. Nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.
• Blood clots. Clots can form in the veins of the leg or arm after surgery. This can be dangerous because a piece of a clot can break off and travel to the lung, the heart or, rarely, the brain.
• Infection. Infection can occur at the incision site or in the deeper tissue. Surgery is sometimes needed to treat it.

Results of Reverse shoulder replacement

69 year old female, treated with Reverse shoulder replacement for cuff tear arthropathy

Preparing for reverse shoulder replacement surgery

Reverse shoulder replacement is usually done as an in-patient procedure. You can discuss the number of days of admission with your surgeon ahead of the procedure.

You can also discuss ways to prepare at home. Your surgeon can advise you about steps such as:

• when to stop taking certain medications, especially medications that affect your blood
• when to shower or bathe before surgery
• how much to eat or drink the morning of your surgery

Most often, a reverse shoulder replacement is done under regional nerve block plus a mild general anesthesia.

No matter what, it’s important to arrange a way to get home. You won’t be able to drive after sedation and surgery; taking public transportation could also pose a risk to your new shoulder joint. It’s recommended that you arrange for someone to drive you and help you get safely. 

What are the movement limitations after reverse shoulder replacement? 

Your doctor will go over your specific movement limitations after reverse shoulder replacement. Immediately following surgery, your arm will be in a sling or brace. You’ll likely be advised not to move your shoulder for at least a few days. 

You’ll have physical therapy sessions scheduled to help strengthen your shoulder and improve your range of motion. The complexity of your surgical procedure will influence your recovery timeline, but most people are able to eat, read, use a keyboard, and dress themselves in about a week. 

Your doctor and physical therapist will let you know when it is safe to return to all standard movements.

Rehab and recovery after reverse shoulder replacement 

Recovery from reverse shoulder replacement surgery generally takes 4 to 8 months. Your surgeon and physical therapist will help you during rehab and recovery. 

You’ll gradually gain strength in your shoulder, and your range of motion will increase. As you recover, you’ll be allowed to take on more activities. For instance, your doctor will tell you when it is safe to drive, return to work, or take on other daily activities. 

At-home exercises for reverse shoulder replacement

You’ll receive at-home exercises advice from your physical therapist. They will tailor these exercises to your recovery. Common exercises for reverse shoulder replacement include:

• Gently stretch your head from side to side.
• Stand with your back to a wall. You should be about 2 feet from the wall. Swing your arm backward gently to touch the wall. 
• Stand with your palms on the wall in front of you. You should be about 3 feet from the wall. Walk your hand slowly up the wall with your fingers.
• Hang a pulley or rope over a door and hold on to both ends. Use your good arm to pull your recovering arm up gently. 
• Sit with your elbow bent and resting on a table. Rotate your shoulder outward. 

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

Your total recovery time will depend on the complexity of your procedure and on how well your shoulder heals. Recovery typically takes between 4 and 8 months. 

Certain factors, such as your lifestyle, can also make a difference. For instance, it generally takes less time to get cleared to return to an office job than a highly physical job.

What is the success rate of reverse shoulder replacement?

Reverse shoulder replacement surgery is highly successful as a pain-relieving procedure. In a study from 2022 including 106 people, for example, 88% reported decreased pain and increased functioning after the surgery and 67% reported returnt to light sporting activity. 

Most people who have reverse shoulder replacement surgery do see an improved range of motion. Yet the success rate for the range of motion is not as high or predictable as it is for pain relief.

Reverse shoulder replacement is approved by the Food and Drug Administration (FDA)Trusted Source in 2003. 

This technique has been used in France since the 1980s, though, and European data shows that reverse shoulder replacements typically last more than 15 years. Depending on factors such as age, activity level, general health, and lifestyle habits, some individuals may even be able to enjoy improved mobility and reduced pain for 20 years or more following their shoulder replacement surgery.

Takeaway 

A reverse shoulder replacement is a joint replacement option for people with a damaged shoulder joint and severe shoulder pain. 

The procedure replaces the damaged shoulder joint by putting the replacement joint pieces in reverse places. The ball joint is attached to the shoulder bone, and the socket is attached to the upper arm bone. 

This surgery is very effective at providing pain relief. Recovery can take between 4 and 8 months and is aided by physical therapy sessions.

FAQ

How does a Reverse Shoulder Replacement work?

• Reverse Shoulder Arthroplasty is a type of shoulder arthroplasty that uses a convex glenoid hemispheric ball and a concave humerus articulating cup to reconstruct the glenohumeral joint.
• The center of rotation is moved inferiorly and medialized which allows the deltoid muscle to act on a longer fulcrum and have more mechanical advantage.

Who will benefit from a Reverse Shoulder Replacement?

Reverse Shoulder Arthroplasty is indicated for conditions such as rotator cuff tear arthropathy, comminuted 4-part proximal humerus fractures and prior failed shoulder arthroplasty.