Arthritis is a wearing away of the smooth cartilage in the shoulder joint. At some point, it may wear down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness. Many patients need surgery to replace the damaged joint.
A reverse total shoulder replacement is an operation that reverses the ball and the socket of the shoulder joint. The ball portion of the replacement joint is attached to the socket and the socket is attached to the upper arm bone, or humerus. This puts the arm back in the socket and makes the joint stable so that the upper arm muscles can power the shoulder. It creates a joint that functions smoothly and does not hurt.
This procedure allows surgeons to treat patients with conditions that have no other solutions. Patients with these problems may need this surgery: older patients with pain and little or no movement due to large rotator cuff tears; patients with severe arthritis; patients with degenerative joint disease and an unstable shoulder joint; and patients who have a failed total shoulder joint replacement or a failed fracture repair.
This procedure is not recommended for people who have infections; problems in the scapula, or shoulder blade; or for patients who do not have good use of their deltoid muscle, the group of three muscles at the top of the shoulder. It is also not recommended for younger patients.
Results vary but they depend on the health of the tissue that surrounds the joint, the degree of the arthritis at the time of surgery and the patient’s activity level. Also, in order to obtain the best results, the patient needs to strictly follow the precautions ordered by the surgeon. After surgery, most patients are better able to perform daily activities such as eating, drinking and combing their hair.
Your orthopedic surgeon will decide if surgery is an option for you. This decision will be based on your history, exam and X-rays. Your orthopedic surgeon will then ask you to decide if your discomfort, stiffness and disability give you enough reason to have surgery. Often, there is no harm in waiting if conservative, non-operative methods are helping to reduce your discomfort.
Age is not an issue if you are in good health and have the desire to keep living an active lifestyle. You may be asked to see your primary care provider or a specialist for his/her view about your general health. Some extra tests may be needed before surgery.
The length of time a shoulder implant lasts varies for each patient and depends on a person’s age, weight, activity level and medical conditions. A total joint implant is a medical device subject to wear that may lead to failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your implant will last for a certain length of time.
Yes, you should consult your surgeon and therapist about the exercises that will help strengthen your entire body before you have surgery. Please read the educational materials provided by your surgeon for more information.
Most surgeries go well, without any problems. Infections and blood clots are two serious complications. To avoid these complications, you will be given antibiotics and blood thinners may be used. The hospital staff takes many precautions to reduce the risk of infection. Early walking, doing ankle pumps and moving around reduce the chance of a blood clot.
It is uncommon to need blood after this surgery. Surgeons use intraoperative medications to minimize bleeding.
Your heart will be monitored during surgery. If it is necessary, your heart will be monitored after surgery during your hospital stay.
Many surgeons advise their patients to stop smoking before surgery and to think about quitting for good. Tobacco products have an adverse effect on blood vessels which can affect the body’s way of healing wounds and bones. The risk of infection and lung problems after surgery is also greater for patients who use tobacco. There are many sources of information offered to help people quit smoking.
Most patients who have reverse total shoulder replacement surgery can expect to be in the hospital for one to two days. You will be discharged as soon as you are comfortable, safe and have met your therapy goals.
Surgery takes about two to three hours. Some of this time is used by the operating room staff to prepare you for surgery.
Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery and you will receive a separate bill from that assistant.
Most patients will be given a regional anesthetic, or arm block, which provides numbness, loss of pain or loss of feeling to your arm. In addition, you will receive a general anesthetic. Your surgeon and the anesthesiologist will discuss anesthesia with you.
You will have discomfort after surgery. We will try to keep you as comfortable as we can. Most patients are able to stop very strong medication within one day and control their discomfort with oral pain medication and the use of ice. On the day of surgery some patients are able to control their own pain medicine with a special pump that delivers a drug right into their IV if ordered by their doctors. This is called Patient Controlled Analgesia, or PCA.
The scar will be four to five inches long and will be along the front of your shoulder.
You will be provided with a shoulder immobilizer prior to or at the time of surgery. The length of time you will need to wear the shoulder immobilizer will depend on your surgeon’s recommendations, but most often it is for a minimum of four to six weeks. You may also need extra home equipment to assist with bathing and dressing. The therapist will provide instruction on any other equipment that you may need.
With proper planning, most patients are able to return to their own homes after discharge. You are encouraged to discuss the timing of your surgery with your surgeon to ensure you will have time to prepare and have assistance arranged. Despite the best planning, some patients will need to be discharged to a subacute facility for a short period before returning home. During the pre-operative education class and your hospital admission, our staff will help you determine if this is necessary for you. You should check with your insurance company to see if you have subacute rehab benefits
You will need a coach, family member or friend to assist you for a few days or a few weeks after your hospital stay. The length of time help is needed depends on your progress. You will need someone to assist you with meal preparations, house cleaning, putting on and removing the shoulder immobilizer, upper body dressing and your home exercise program. If you need a home healthcare nurse to come to your home, arrangements may be made if you qualify for that service. If you prepare before your surgery, you can reduce the amount of extra help you will need. It is best to have the laundry done, house cleaned, yard work done, clean linens put on the bed and single portion frozen meals made.
Depending on your surgery, your surgeon may want you to have physical therapy after discharge from the hospital. For the majority of patients this therapy will begin shortly after discharge and take place in an outpatient physical therapy clinic. Our care coordinator will help you make these arrangements, if they are not already in place prior to surgery. If for medical or safety reasons attending outpatient physical therapy is not appropriate, the care coordinator will help you make arrangements for in-home physical therapy as required.
You will wear a shoulder immobilizer for a number of weeks after surgery. You will need to perform all activities one-handed or receive help from your family members or friends. This will affect many of your normal activities.
Patients are not allowed to drive for a certain period of time after reverse total shoulder joint replacement surgery. Ask your surgeon when you will be able to drive.
You should take off work until after you are seen for your first post-operative follow-up visit 10 to 14 days after your surgery. Then you can discuss with your surgeon when you may be able to return to work. A therapist can make recommendations for protecting your joint and saving energy on the job.
You will be seen for your first postoperative office visit 10 to 14 days after discharge from the hospital. After that, many patients are seen at six weeks, 12 weeks and then yearly. This will depend on how well you recover.
Patients are to wear the shoulder immobilizer at all times except for exercising, bathing and upper body dressing. Some patients are not allowed to actively move or functionally use the arm for four weeks – and sometimes longer. Your surgeon and therapist will instruct you about precautions and restrictions. Do not resume any activities or exercise after surgery without checking with your surgeon or therapist.
The goal after total shoulder replacement surgery is to have a shoulder joint that feels like a normal functioning shoulder. Most patients have no pain in their shoulders and have improved function after surgery.