Frozen Shoulder
What is Reverse Shoulder Arthroplasty Surgery?
In the US, hundreds of effective conventional total shoulder replacements are performed each year for individuals suffering from shoulder arthritis. However, individuals with extensive rotator cuff tears who have acquired "cuff tear arthropathy," a complex form of shoulder arthritis, are less likely to benefit from this sort of treatment. Reverse total shoulder replacement may be a possibility for these patients, as traditional total shoulder replacement may cause pain and limited range of motion.
Description
A metal "ball" is fastened to the top of the upper arm bone (humerus) and a plastic "cup" is inserted into the shoulder socket (glenoid) to replicate the natural anatomy of the shoulder. The metal ball and socket are exchanged in a reverse complete shoulder replacement. The plastic cup is attached to the humerus's upper end, while the metal ball is linked to the socket.
Because total reverse shoulder arthroplasty uses different muscles to move the arm, it is more effective for patients with cuff tear arthropathy. The rotator cuff muscles aid in positioning and powering the arm during range of motion in a healthy shoulder. The rotator cuff muscles are also necessary for a traditional replacement device to operate correctly. These muscles stop working in a patient who has a significant rotator cuff tear and cuff tear arthropathy. In a reverse total shoulder replacement, the arm is powered and positioned by the deltoid muscle rather than the rotator cuff.
This procedure was first developed in Europe in the 1980s. Its usage in the US was authorized by the Food and Drug Administration (FDA) in 2003.
Candidates for Surgery
Shoulder replacement in reverse may be advised if you have:
- A rotator cuff that is totally ripped and irreparable
- The arthropathy of cuff tears
- An failed shoulder replacement in the past
- Excruciating shoulder pain and trouble raising your arm above your head or away from your side
- Other therapies that have failed to alleviate shoulder discomfort include rest, medicine, cortisone injections, and physical therapy.
Preparing for Surgery
You will receive assistance from your orthopaedic specialist in organizing and getting ready for your shoulder surgery.
Medical Evaluation
- Prior to surgery, the majority of patients must undergo a thorough physical examination by their primary care physician. This is necessary to ensure that you are healthy enough to have surgery and recover fully. Prior to surgery, many individuals with long-term health issues, such as heart disease, need to be assessed by a specialist, such as a cardiologist.
Medications
- Make sure to discuss your prescriptions with your orthopedic physician. Prior to surgery, several drugs might need to be stopped. For instance, the following over-the-counter medications should be avoided two weeks before to surgery since they may result in significant bleeding:
- Non-steroidal anti-inflammatory drugs, including naproxen sodium, ibuprofen, and aspirin
- The majority of arthritis drugs
If you use blood thinners, your cardiologist or primary care physician will advise you to cease taking them prior to surgery.
Home Planning
- Your recuperation time can be shortened by making little adjustments to your house prior to surgery.
- Reaching high shelves and cupboards will be challenging for the first several weeks following your surgery. Make sure to go through your house before your surgery and put anything you might need later on low shelves.
- After you leave the hospital, you will want assistance for a few weeks with daily activities such as laundry, cooking, bathing, and dressing. You might require a brief stay in a rehabilitation center till you gain more independence if you won't have any help at home right after surgery.
Before Your Operation
- When you travel to the hospital for surgery, dress comfortably in loose-fitting clothing and a button-up shirt. Following surgery, your arm will be in a sling and your range of motion will be restricted.
- The day of your surgery, you will probably be admitted to the hospital. Following admission, a physician from the anesthesia department will meet you in the preoperative preparation area.
- The type of anesthesia to be used will be discussed by you, your surgeon, and your anesthesiologist. You might be given a regional anesthetic, which leaves you feeling nothing around the surgical site, a general anesthetic, which puts you to sleep for the duration of the procedure, or a combination of the two.
Surgical Procedure
- It typically takes two hours to replace your shoulder joint with an artificial device.
- Either the front or the top of your shoulder will be cut by the surgeon. To get your shoulder functioning again, he or she will remove the damaged bone and then place the replacement parts.
Surgical Complications
The process of replacing a shoulder completely in reverse is very complicated. Your surgeon will thoroughly assess your unique circumstances and go over the risks of surgery with you.
Any procedure has the risk of infection and bleeding. Wear, loosening, or displacement of the components are complications unique to a total joint replacement. The replacement shoulder joint can require revision or re-operation if any of these happen.
Recovery
Following surgery, your healthcare team will prescribe painkillers to keep you comfortable and many doses of antibiotics to prevent infection. The day following surgery, the majority of patients are able to move around and eat solid food. On the second or third day following surgery, you should be allowed to return home.
Rehabilitation
- Your arm will be in a sling when you go out of the hospital. To improve your endurance and mobility, your surgeon could advise you to perform mild range-of-motion exercises. Additionally, a structured physical therapy program might be suggested to increase your shoulder's strength and flexibility.
- After surgery, you should be able to eat, dress, and groom yourself in a few weeks.
- To keep an eye on your shoulder, your surgeon might ask you to come back for follow-up appointments and x-rays.
Do's and Dont's After Surgery
- Do adhere to your doctor's recommended at-home fitness regimen.
- For the first six weeks, do not place your arms in extreme positions, such as behind your torso or straight out to the side.
- Don't go overboard.
- For the first six weeks following surgery, avoid lifting anything heavier than five pounds.
- Avoid pushing yourself out of a bed or chair because this calls for strong muscle contractions.
- After having a shoulder replacement, avoid doing heavy lifting tasks repeatedly.
