Reverse Total Shoulder Replacement

What is a reverse total shoulder replacement?

A reverse total shoulder replacement is a special type of shoulder surgery. During the surgery, your surgeon removes the damaged parts of the shoulder and replaces them with artificial parts.

The shoulder joint is made up of the upper arm bone (humerus) and the shoulder blade (scapula). The rounded end of the upper arm bone moves inside a shallow socket in the shoulder blade. Because of this, your shoulder normally has a wide range of motion. Cartilage, tendon, and ligaments around the joint also provide support and help the joint move smoothly.

During the surgery, your surgeon removes the rounded head of the upper arm bone. Using screws and special tools, they attach a plastic socket to the remaining bone. The surgeon also removes part of the socket of the shoulder blade. This is then replaced with a metal ball. The metal ball can then move around inside the socket that attaches to the upper arm bone.

This is different from a standard total shoulder replacement. In the standard surgery, a plastic cup is fitted into the shoulder socket. Then a metal ball is attached to the humerus. This more closely follows the shoulder's normal anatomy.

Healthcare providers suggest reverse total shoulder replacements for certain types of shoulder injuries. The most common type is arthritis with a large rotator cuff tear.

Why might I need a reverse total shoulder replacement?

Surgery may be an option for you if you have severe pain that gets in the way of everyday activities. Surgery may also be advised if you have weakness in your shoulder and are not able to move it fully. It may also be advised if your symptoms don’t get better with other treatments. These may include medicines, shots (injections), and physical therapy.

Some people get a standard total shoulder replacement. But reverse total shoulder replacement works better for those with large rotator cuff tears. If you have this type of injury, a standard shoulder replacement might still leave you with some pain and limited movement. A reverse total shoulder replacement usually improves these problems. After surgery, instead of using the rotator cuff to lift up your arm, you can use your deltoid muscle. This is a muscle that helps lift the arm up and away from the body.

Healthcare providers also may advise this surgery to people who have already had a standard shoulder replacement for osteoarthritis or other reasons. These people may still have symptoms that a reverse total shoulder replacement can fix.

What are the risks of a reverse total shoulder replacement?

Every surgery has risks. Risks for this surgery include:

• Infection

• Excess blood loss

• Damage to the surrounding nerves (which might limit arm movement)

• Break (fracture) of one of the shoulder bones

• Dislocation of the artificial joint

• Wear or loosening of the artificial parts that would require another surgery

• Complications from anesthesia

Some of these risks may be higher in people having a repeat surgery. Your own risks may vary depending on the anatomy of your shoulder problem and your general health. Ask your healthcare provider about the risks that most apply to you.

How do I get ready for a reverse total shoulder replacement?

Talk with your healthcare provider about how to prepare for your surgery.

• Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements.

• Ask if you need to stop taking some medicines before the surgery, such as blood thinners.

• Follow all instructions about eating or drinking before your surgery.

• Follow any other instructions from your healthcare provider.

Before your surgery, you may need imaging tests. These will give your healthcare provider more information about your shoulder. These might include:

• X-ray

• CT scan to see the bones in more detail

• MRI to see the soft tissue around the bones in more detail

What happens during a reverse total shoulder replacement?

Your healthcare provider can explain the details of your surgery. An orthopedic surgeon will do the surgery. They will be helped by a team of specialized healthcare providers. The procedure will take several hours. In general, you can expect the following:

1. You will likely have general anesthesia. This will make you sleep through the surgery.

2. You might also get a shot (injection) that blocks the nerves in your shoulder and arm. Some people have this instead of general anesthesia.

3. An anesthesiologist will check your vital signs during the procedure.

4. Your surgeon will make a cut through the skin near the top of your shoulder. They will also need to cut through the layer of muscle beneath.

5. Your surgeon will remove the damaged section of the humerus and the scapula. Using special screws, they will attach the metal ball to your scapula and the plastic socket to the top of the upper arm bone.

6. Your surgeon may place a tube to drain extra fluid in the joint. This tube will be taken out later.

7. After the new joint is in place, your surgeon will close the muscles and skin with stitches or staples.

What happens after a reverse total shoulder replacement?

Ask your healthcare provider about what you should expect after your surgery. In general, after your surgery:

• Your operated arm may be numb from the anesthesia. You also may not be able to move your hands or fingers. This will last for several hours.

• You may have some pain, but pain medicines should help as needed.

• You might use a device to keep ice on your shoulder.

• You’ll probably need follow-up X-rays to make sure your surgery was successful.

• Your arm will probably be in a sling after the surgery for several weeks.

• You will probably begin physical therapy exercises while you are still in the hospital.

• You should be able to have a normal diet as soon as you can handle it.

• You may need to stay in the hospital for 1 to 3 days.

You’ll have some pain as you heal after the surgery. But your original shoulder pain should be improved.

Follow all your healthcare provider’s instructions about caring for your shoulder and wound. This might include continued icing of your shoulder and physical therapy. A little bit of fluid leaking from the wound is normal. But let your healthcare providers know if swelling gets worse, you have bleeding, fluid leaking out, or redness or pain happens. Also tell them if you have a fever or chills.

Your healthcare providers can let you know when you will be able to use your hand and arm more fully. You will probably be able to use your wrist and hand soon after your surgery. You won’t be able to use your arm for several weeks, though. Most people can return to light work within a few weeks.

Make sure to keep all your follow-up appointments with your all your healthcare providers. Keeping in close touch with them can help you have the best possible outcome. Most joints will last several years before they will need to be replaced.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure