Do you have unbearable shoulder pain? Perhaps you are struggling to do simple tasks like lifting your arm, combing your hair, or picking up something upstairs. If the pain doesn't subside with standard treatments, your doctor may have recommended shoulder replacement surgery. Today, we're talking about a similar, but slightly different, surgery. It's called a 'Reverse Shoulder Replacement'.
What is this 'Reverse' Shoulder Replacement?
Simply put, this is also a joint replacement surgery. Doctors sometimes call it a ``Reverse Total Shoulder Arthroplasty.`` In this surgery, the surgeon removes your natural, damaged shoulder joint and replaces it with an artificial joint ``prosthesis`` made of metal and plastic.
Now let's see why this is called 'Reverse'.
Think of our shoulder joint as a cup with a ball in it. The shoulder joint is usually formed by the cup-like part of your shoulder bone (scapula) (the glenoid) and the ball-like part of your upper arm bone (humerus) (the head).
In a 'reverse' surgery, the opposite is true. The surgeon switches the positions of the ball and the cup. After the surgery, the ball is made to come out of the shoulder bone (scapula) and the cup is made to fit into the upper arm bone (humerus). In other words, the normal configuration is completely reversed.
Why is 'reverse' surgery performed in this way? Who is it suitable for?
This 'Reverse' surgery is recommended for people with special health conditions who cannot undergo a regular shoulder replacement surgery. If you have severe pain in your shoulder or difficulty moving your arm, your doctor will first try things like medication and physical therapy. Only if these don't work will surgery be considered.
In particular, if you have arthritis of the shoulder joint along with one or more of the following conditions, your doctor may suggest this 'reverse' surgery.
| Health status | Simple explanation |
|---|---|
| Severely torn `(Rotator Cuff)` tissue | Severe damage to the muscles and tissues around the shoulder that help lift the arm. This damage makes it impossible to maintain stability if a normal joint is replaced. |
| Shoulder Fracture | A severe fracture of the shoulder joint. |
| Chronic Dislocation | If the shoulder joint is frequently dislocated, the surrounding tissues become weak and normal surgery will not be successful. |
| Severe damage to bones | If the bones in the joint have worn down and become severely damaged due to arthritis or another disease. |
| Cancerous or other tumors in the joint | If the bones have been damaged due to tumors around the shoulder joint. |
In cases like this, the muscles and tissues around the shoulder are weak, so a traditional shoulder replacement cannot provide the necessary stability. However, by swapping the ball and socket in the 'Reverse' method, a different muscle group (for example, the deltoid muscle) can be used to lift the arm. This provides better stability to the joint and reduces the risk of complications.
How do you prepare before surgery?
Your surgeon will prepare you well before the operation. This may include:
- A dental checkup: This is important to reduce the risk of infection after surgery.
- A complete physical examination: See if you are healthy enough to undergo surgery.
- ECG test: Check the health of your heart.
- Blood tests: Know the status of your blood and other things.
- Imaging tests: A shoulder X-ray, MRI, or CT scan can help to better assess the condition of the joint.
Most importantly, tell your doctor about all the medications you are taking (both prescription and over-the-counter pain relievers and vitamins). Some medications may need to be stopped a few days before surgery.
Your doctor will also advise you on when to stop eating and drinking the day before surgery. Usually, you will need to stop eating and drinking 8 hours before surgery.
What happens during the surgery?
On the day of the surgery, you will be given anesthesia so that you will not feel any pain. The anesthesiologist will either give you medicine to put you completely to sleep (general anesthesia) or to numb only the area around your shoulder (regional anesthesia).
During the operation, the surgeon follows these steps:
1. A small incision will be made in the skin near your shoulder.
2. Damaged cartilage and bone fragments are removed from the joint.
3. The prosthesis is inserted.
4. The metal ball is screwed into the shoulder bone (scapula). The socket is inserted into the upper arm bone (humerus).
5. The new joint is properly prepared, and the incision is closed with stitches.
This surgery usually takes about an hour or two, but this time can vary depending on the extent of damage to your joint.
What are the benefits and possible risks of this surgery?
The biggest benefit of this surgery is that the severe pain and stiffness in the shoulder is greatly reduced. You can use and lift your arm better than before the surgery. Also, this is a good solution for those who cannot undergo regular shoulder surgery.
Like any surgery, there are some risks involved, but these are very rare.
- Blood clots
- Damage to blood vessels
- Bone fracture around the implant
- Infection at the surgical site or within the joint
- Nerve damage
- Premature loosening or wear of the implanted artificial joint
What happens after the surgery? How long does it take to recover?
After the surgery, you will be taken to a recovery room, where the medical staff will take good care of you until the effects of the anesthesia wear off. You may be able to go home the same day. Or you may need to stay in the hospital for a day or two.
It may take about 6 months to fully recover.
- The first few weeks: You will need to wear a sling.
- Pain management: You should use painkillers and other medications (NSAIDs) as prescribed by your doctor, if necessary.
- Physical Therapy: After a few weeks, you will see a physical therapist. He or she will teach you exercises to strengthen your shoulder muscles and increase your range of motion. Doing these exercises correctly is essential for a speedy recovery.
- Restrictions: You will need to avoid heavy lifting and sports for a few months. You can gradually resume your normal activities after your doctor gives you permission.
How long does this surgery last?
These artificial joints last a long time, often for 15 years or more without any problems. Many people can use this implanted joint for the rest of their lives.
When to see a doctor after surgery
If you experience any of the following symptoms after surgery, call your doctor immediately. If you experience severe chest pain or difficulty breathing, go to the nearest hospital's Emergency Department (ETU) immediately.
| Warning signs to look out for | |
|---|---|
| • Bleeding from the cut | • Chest pain |
| • Fever greater than 101 Fahrenheit (39 Celsius) | • Difficulty breathing (dyspnea) |
| • Severe pain that does not subside despite taking painkillers | • New or increasing pain in the hand or wrist |
| • Signs of an infection: pus-like fluid draining from the incision, swelling, discoloration, odor, or an unusually warm feeling. | |
Take-Home Message
- 'Reverse Shoulder Replacement' is a special surgery performed on people who cannot undergo regular shoulder surgery due to severe rotator cuff damage or other special reasons.
- In this surgery, the ball and socket of the shoulder joint are repositioned, allowing the arm to move using different muscles.
- This will relieve your severe pain and help you carry out your daily activities without pain.
- It takes several months to fully recover, and it is very important to follow physical therapy and medical advice.
- If you experience any unusual symptoms (especially signs of infection, severe pain) after surgery, notify your doctor immediately.
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