Reverse shoulder replacement surgery differs from standard replacement because the ball and joint of the shoulder switch places. In essence, the socket rotates on the outer side of the ball. This is a complicated surgery warranted by certain conditions. It provides significant pain relief and helps improve range of motion of the joint, although after surgery there is some limitation.
The main reason for this complex procedure is arthritis but, there are other reasons as well:
- the rotator cuff tendons are gone or torn.
- Shoulder remains painful after a routine shoulder replacement
- Fracture in the proximal humerus (nearest the joint)
- bone is shattered or splits into pieces
- tumor in the humerus shaft or the ball of the humerus
In the event of torn or missing rotator cuff tendons, a person is unable to lift the arm enough to be functional. There may or may not be pain but the main reason for replacement is to regain functionality and motion.
There are instances when the procedure is not advised. Individuals should avoid this procedure if:
- The socket bone of the shoulder blade (scapula) is too deteriorated that implants cannot be attached with screws or a bone graft is needed before placement can be done
- ongoing infection in the shoulder
- previous infection – increases post-operative risk of infection
- rotator cuff cannot be repaired
- complex fracture of the shoulder
- other treatments did not work (meds, rest, etc)
Surgical risks include bleeding, nerve damage, and possible infection. There may be surgical complications such as:
- humerus or arm portion (the socket) can become dislodged from the ball (the shoulder blade part) and the prosthesis is “dislocated.”
- the arm portion of the prosthesis can make contact with the bone of shoulder blade in certain positions
- tingling, numbness and weakness with nerve damage
- Injury to blood vessels
- conditions, such as blood clots in the legs (deep venous thrombosis)
- pulmonary embolus
- heart attacks and strokes
- drug or anesthetic reactions
After surgery, several doses of antibiotics are given to reduce the risk of infection. Pain medication will help relieve pain. Most patients can eat a solid diet and get out of bed the day after surgery. Discharge to go home is on the second or third day after surgery.
The arm will be in a sling on discharge from the hospital. The surgeon may provide instruction for gentle range of motion exercises to build mobility and endurance. Physical Therapy may also be ordered.