If you’re a candidate for any kind of shoulder surgery, you’re most likely looking into all possible solutions and information about the type of shoulder surgery you’ve been recommended – as well as the possible results and side effects.
If you have a torn rotator cuff and corresponding weakness in your arm, you may be a candidate for a reverse shoulder replacement surgery.
Reverse shoulder replacement surgery or a reverse total shoulder replacement are often advised for people who have torn rotator cuffs as well shoulder joints that have been damaged by severe arthritis, severe shoulder fractures (especially when they involve the glenoid area), or when a previous less invasive type of shoulder replacement has failed.
In a patient that has large rotator cuff tears or injuries are referred to as “cuff tear arthropathy.” A reverse shoulder replacement allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.
During these types of surgeries, the glenoid is replaced totally with either a plastic component that requires cement to be fixed in place or a metal component with screws, and the humerus to be replaced with new stem or head that may or may not be cemented in place.
Reverse shoulder replacement vs total shoulder replacement
A total shoulder replacement requires an intact rotator cuff muscle in order to balance the shoulder placement and help provide the necessary functionality to the replacement joint.
What makes a reverse shoulder replacement different from a total shoulder replacement is that the glenoid and humerus components are switched (the ball and socket parts of the shoulder joint switch sides), and it relies on the deltoid muscle instead of the rotator cuff. This type of surgery is gaining popularity worldwide due to its versatility.
Preparing for reverse shoulder replacement surgery
Before you go in for shoulder replacement surgery (and keep in mind that we’re assuming you’ve already consulted with your orthopaedic surgeon) make sure that you have everything set at home first.
Have a spouse, partner, family member, or close friend on hand to help you out post-surgery since you won’t be able to lift things or even do simple tasks for around four to six weeks after your reverse shoulder replacement.
Stocking up on prepared foods (frozen meals are your friend) and scheduling things like cleaning services if you can is also a good idea.
You should also move commonly used items to lower shelves or drawers or similar easy-to-access spots, since it’s going to be a while before you regain your previous range of movement.
Think about all the times you lift your arms above shoulder height in a given day and try to rearrange your home accordingly. Your future self will thank you!
Your reverse shoulder replacement surgery
All shoulder replacement surgeries are highly technical, and reverse shoulder replacement surgery is no exception. Used for patients who have torn rotator cuff tendons and corresponding arm weakness and pain, complicated shoulder fractures, joints that have been severely damaged by arthritis, or situations where a previous replacement has failed.
Essentially, this type of surgery is recommended when previously operations haven’t worked or there’s been severe trauma to your shoulder joint. It is a fairly extensive procedure, so prepare yourself and your lifestyle accordingly, and know that rehabilitation won’t be easy.
Before your operation
It’s important to understand that you’ll have issues lifting things – even lightweight or small items like silverware or a pen – and otherwise performing daily tasks for a fairly significant time after your shoulder surgery.
Making sure that you have support from your spouse, partner, family, and friends in advance will help aid your recovery and even improve your peace of mind. Considering scheduling things like cleaning services, dog walkers, grocery delivery, and other household help if you are able to as well.
You will also likely have trouble sitting up in bed right away, or even pushing yourself up in a chair. But it’s all for the greater good and once you recover from your shoulder surgery you’ll be happy you went through it. Overall, the more you prepare in advance for your surgery, the better off you’ll be.
Reverse shoulder replacement surgical procedure
This type of surgery is typically called for with patients with cuff tear arthropathy or similar issues where the muscles in their shoulder no longer function properly. It relies on the deltoid muscle instead of the rotator cuff.
This type of surgery is more extensive and it is used in cases where the shoulder is too damaged for a conventional replacement; cases where a simpler surgery would still leave the patient in pain and unlikely to be able to lift their arm above a 90-degree angle – which is of course severely debilitating and makes many basic tasks or life activities difficult if not impossible.
Conventional shoulder replacements use the existing rotator cuff muscles along with a replacement device to power and position your arm, giving you a fuller range of motion and helping to prevent future issues. On the contrary, reverse shoulder replacements are a total replacement and use the aforementioned deltoid muscle as a stabilizer. It involves attaching a metal ball to the shoulder and a plastic socket to the arm bone, allowing the recipient to use their deltoid muscle to lift their arms.
Reverse shoulder replacement complications
Bleeding, nerve damage, and other complications can all happen as a result of a total joint replacement surgery, like a reverse shoulder replacement surgery. Overall wear, loosening, or dislocation may require a revision or another operation.
Pain management after a reverse shoulder replacement surgery can involve a variety of medications, including opioids. Consult your doctor about how the various medications (including pain killers) might affect your overall health along with your previous medical history.
Reverse shoulder replacement recovery time
Physical therapy will be a large part of your recovery from your shoulder surgery. You will essentially have to re-educate or rediscover your shoulder function, which might require everything from basic exercises to long term physical therapy. This will likely also involve prescription medications, at least in the immediate days after the surgery.
The immediate aftermath will be most likely be fairly simple, with antibiotics and painkillers being standard. You should be able to go home within several days, but will need a fair amount of help as previously described, since you won’t be able to use your affected shoulder. Your arm will likely be in a sling for four weeks, but you should be able to groom yourself and otherwise take care of things on your own within a couple weeks post-surgery.
It’s also important to keep in mind that dealing with the after-effects from this type of surgery may require months if not years, so you need to plan accordingly. You’ll have to avoid any type of light lifting with the affected arm for at least six weeks and any reasonably heavy lifting for at least six months. You will also not be able to drive a car for six weeks.
This might be a problem for everything from basic day to day activities, to food prep, to taking care of your kids or your pets, doing laundry, and other daily tasks, so keep all of that in mind when you are planning your recovery time before your reverse shoulder replacement surgery.
That said, once you are fully recovered from your surgery, your pain relief levels should be high, and you should be able to do basic things like lift your arm over your head and otherwise do normal lifestyle activities – that said, you’ll probably never be MLB pitcher or an AFL star, but really did you expect that anyways?
The immediate goals of your reverse replacement shoulder surgery are to manage your pain, so this will likely include pain killers and associated medications along with physical therapy.
Follow the recommendations from your doctor as to how to manage your pain and rehab your shoulder after this type of surgery, from using medications appropriately to visiting their office or hospital for x-rays or other follow-up treatment, as well as any physical activity or therapy.
Reverse shoulder replacement protocol & rehabilitation
There are a lot of steps involved in rehabbing your shoulder joint after a reverse shoulder replacement surgery. For instance, you will need to keep your movements within the safe zone, so a maximum 90° elevation, 30° external rotation. Which is why you need the aforementioned helpers and post-surgery plan.
You can progress to active assisted and support range of movement within this safe zone, but for the time immediately after your surgery there will be no combined external rotation/abduction, no shoulder extensions, and no putting your hands behind your back (all of which will likely be painful post-surgery).
On the other hand, you should be doing activities like external rotation control exercises and scapular setting exercises meant to optimise deltoid function and help your body reinvent itself.
Once you are two to four weeks post-surgery, you’ll be able to start doing more complex exercises, including weight bearing or loaded movements, internal and external rotation exercises, and other functional activities meant to re-establish patterns of movement in your shoulder joint.
Know that it may take at least two years to rehab your shoulder after this sort of extensive surgery, and that a reverse shoulder replacement is something that you will need to work closely with your orthopaedic surgeon and their team to fully recover.
Candidates for a reverse shoulder replacement
If you have a completely torn rotator cuff, a complex shoulder fracture, chronic shoulder dislocation, severe shoulder pain, cuff tear arthropathy, and have tried numerous other treatments, then you may be a candidate for this sort of shoulder surgery.
It’s not an easy decision and may require some time to recover, but if your shoulder joint issues are having a significant negative impact on your life, it may very well be worth it. Consult with your doctor or orthopaedic surgeon to determine the best solution for you and your lifestyle.