SHOULDER

Reverse Shoulder Replacement

Reverse shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear. In a reverse shoulder replacement, the socket and metal ball are opposite to a total shoulder replacement. The metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus. It relies on the deltoid muscle rather than the rotator cuff to move the arm therefore is more suited to patients with rotator cuff arthropathy.

Reverse shoulder replacement may be recommended for the following situations:

  • Completely torn rotator cuff that is difficult to repair
  • Presence of cuff tear arthropathy (when the rotator cuff is torn, leading to wear and tear of the shoulder joint and eventually arthritis)
  • Previous unsuccessful shoulder replacement
  • Severe shoulder pain and difficulty performing overhead activities
  • Continued pain despite other treatments such as rest, medication, cortisone injections and physical therapy



Procedure

First an incision is made over the affecter shoulder to expose the shoulder joint. The humerus dislocated to separate it from the glenoid socket of the scapula (shoulder blade). The arthritic parts of the humeral head and the socket are removed and prepared for insertion of the artificial components. The artificial components include the metal ball that is screwed into the shoulder socket, and the plastic cup that is cemented into the upper arm bone. The artificial components are then fixed in place. The joint capsule is stitched together, tissues approximated and the wound closed.


After Your Operation

Pain Management

During your inpatient stay you will be given pain relief and either medication or prescriptions to go home to keep pain within comfort. Usually patients will initially require regular pain relief consisting of paracetamol and anti-inflammatories if indicated. Stronger medications may be given and helpful in early stages however are phased out as comfort levels increase. Regular ice packs on the shoulder for approximately 20 minutes, three to four times a day can help reduce swelling and pain.

Return to Work and Sport

Return to work will vary depending on the nature of your work. After surgery, your arm will be placed in a sling for two to four weeks. In general, you should plan to have at least two weeks off work to allow adequate time for your shoulder to heal while your arm is in a sling. You may be able to return to light duties after approximately two weeks, but if your work is physically active and involves lifting, pushing, pulling or overhead activities, it may take up to twelve weeks to return. Returning to sport is dependent on the activity and extent of surgery.  Dr du Sart will discuss your return to activity at your post-op check.


It is important to follow the physical therapy exercises you are provided to increase shoulder mobility and strength.


Driving

Times to return to driving will vary. However, in general, plan to avoid driving for approximately six weeks and until your sling is removed. If you have concerns, you can discuss this with Dr du Sart.

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