Reverse Total Shoulder Arthroplasty

What is Reverse Total Shoulder Arthroplasty?

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 very wide range of motion. Cartilage, tendon, and ligaments around the joint also provide support and help the joint move smoothly.

In a reverse total shoulder replacement, a surgeon removes the rounded head of the upper arm bone. Using screws and special tools, he or she attaches 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 a standard surgery, the metal ball attaches to the upper part of the humerus. The new socket attaches to the shoulder blade. This more closely follows a person’s real anatomy.

Signs and Symptoms

• A visibly deformed shoulder
• Extreme or constant pain in the shoulders
• Arthritis
• Swelling or bruising
• Inability or stiffness
• Bump on the top of the shoulder area
• Weakness in the arm or shoulder
• Shoulder movement gets limited

Tests and Diagnosis

Before your surgery, you may need imaging tests. An x-ray will give your provider information about the bones in your shoulder, a CT scan will provide a detailed image of the bones, and an MRI will give your provider more detailed information about the soft tissue around the bones.

Reverse Shoulder Replacement Surgical procedure

Reverse shoulder replacement is an advanced procedure in orthopaedics that replaces the damaged-cartilage joint with a prosthetic implant. The surgery is a specialized form of partial shoulder arthroplasty, a surgical procedure that involves the surgical replacement of the ball and socket joint between the upper arm bone (humerus) and the glenoid portion of the scapula. The surgery is performed in two stages.

In stage one, called “explantation”, the surgeon carefully disassembles the affected joint through an incision over the top of the patient’s shoulder. The ball-and-socket joint is separated, and the inner shell of bone and cartilage is removed from within the socket. The lower end of the humerus is then drilled down to receive a metal sleeve prosthesis, into which a plastic ball will later be inserted.

Stage 2 involves re-setting this new polyethylene hollow cylinder over top of the humerus (metal sleeve), reattaching muscle tendons to it, and then remounting this new shoulder joint into its normal position overtop of the shoulder blade (scapula), where it is secured in place with screws.

Recovery

After surgery, your medical team will give you several doses of antibiotics to reduce your risk for infection, and pain medication to keep you comfortable.

Some patients are able to go home the same day as their surgery, while others need to be admitted to the hospital overnight. Most patients who are admitted go home the next day. Your surgeon will talk to you about whether an overnight stay or same-day discharge is appropriate for you.