Reverse Total Shoulder Arthroplasty

Arthroplasty is a surgical procedure performed by an Orthopaedic surgeon to restore function and relieve pain in an abnormal or diseased joint.  This can be achieved by altering or completely replacing the affected joint.  Arthroplasty is also performed if cartilage has deteriorated due to arthritis, disease or other degenerative or traumatic conditions.

About your Shoulder

The shoulder is one of the most complex and largest joints in the body.  The humerus (upper arm bone) has a round end that fits into the curve on the outside of your scapula (shoulder blade) like a ball and socket, allowing your arm to move up and down, back and forward and rotational.

Ligaments and tendons work to hold your shoulder together.  Ligaments attach the bones whereas tendons attach muscles to bone.  Cartilage keeps the bones apart, preventing them from rubbing together.

What is a Reverse Procedure?

A reverse total shoulder arthroplasty is a complex procedure warranted by certain conditions such as arthritis or torn rotator cuff tendons.  The main difference between a standard shoulder replacement and a reverse procedure is that during a reverse total shoulder arthroplasty the ball and socket element of the shoulder switches sides, causing their natural position to be reversed.

A standard total shoulder replacement relies on the muscles and tendons surrounding the shoulder being intact. Muscles and tendons in the shoulder function to allow motion and are together known as the rotator cuff.  When these tendons become extensively torn to the point that they no longer attach to the bone, the shoulder does not function as usual, causing pain and loss of movement.  A reverse prosthesis is designed for cases where the rotator cuff is malfunctioning or torn.

Replacing the damaged surfaces with a prosthesis and reversing the position within the shoulder can help reduce pain and increase the range of motion available in your shoulder joint.

Causes

The primary cause for a reverse total shoulder arthroplasty is arthritis of the shoulder and torn rotator cuff tendons.  In this situation, the operation will give the patient significant pain relief and may help with function of the shoulder.

Another reason that you may undergo a reverse total shoulder arthroplasty is the inability to lift the arm high enough to function due to torn rotator cuff tendons.  The shoulder is generally not painful in this case; however, the inability to lift the arm can negatively affect daily life.  When the patient lifts their arm and there is a prominence on the front of the shoulder, this is referred to as an anterior- superior migration or subluxation of the shoulder.  In this case, pain may be a prominent factor for the reverse prosthesis, but the reason for the replacement is mainly to regain function and movement.

The other most common reason to undergo a total should arthroplasty is if the shoulder has already had a replacement and you are still experiencing pain and limited movement.  If a reverse prosthesis is necessary following previous shoulder surgery, the procedure is a little more complicated.  This is because the first traditional shoulder replacement will need to be removed during surgery and then replaced with the reverse prosthesis.

Other reasons to have a total shoulder arthroplasty include:

• Shoulder fracture, in particular fractures that involve the humerus where the ball attaches to the shaft of the bone
  Tumour in the humerus or shoulder joint
• Chronic shoulder dislocation
• Other treatments have failed.  If you have tried rest, medications, cortisone injections and physiotherapy, but they have not helped

Before the Procedure

Prior to your surgery, you will come in for a pre-assessment where a nurse will carry out a physical examination to confirm you are healthy enough to undergo the procedure and complete recovery.  You will be asked about medications you are taking, as some may need to be stopped before surgery as they may cause excessive bleeding.

It is important to get your home prepared for your recovery following your procedure.  It is likely that you will not be able to reach for high shelves or cupboards therefore; it is advised that you move any items onto lower shelves that you will need access to.

You will require assistance with everyday tasks such as bathing, cooking and dressing in the weeks following the procedure.  Speak to your doctor about aftercare options if you do not have any close friends or relatives available to help.

The Procedure

Reverse total shoulder arthroplasty is typically carried out under a general anaesthetic and takes approximately 1 – 3 hours.  

Surgery involves making an incision at the front of the shoulder.  The surgeon separates the muscles and then cuts through the tissue to expose the joint.  The head of the humerus (arm bone) is removed from the socket in preparation to receive the artificial replacement.  The glenoid (socket) is also prepared, replaced and reversed with a prosthesis to allow smooth movement.  The tissue is then sewn together around the joint and the incision is closed.

Post-Operative Recovery

You will be required to stay in hospital for approximately 3 days following your procedure in order to begin your recovery.  A Physiotherapist will teach you some basic exercises to help with rehabilitation, along with how to use your sling.  They may also offer advice with how to manage day-to-day tasks after the surgery, as well as arrange some follow-up physical therapy for you.

You will be required to attend a follow-up appointment where your wound will be checked.  Your stitches will also be removed and a fresh dressing applied, if necessary.

Pain following the procedure is entirely normal.  You will be offered a combination of pain relieving methods to help ease the pain.  It can take several months for the pain to settle; however, long-term pain should be significantly reduced compared to before your operation.  Icing the shoulder may help ease pain and minimise swelling.  This should be carried out for approximately 10 – 15 minutes each time, roughly 3 times a day (wrapped in a tea towel to avoid direct contact with skin).

Risks and Complications

A reverse total shoulder arthroplasty is a commonly performed procedure, rarely resulting in complications.  However, as with any surgery, you need to be aware of the possible side-effects and complications or risks.  Possible complications include:

• Infection
• Bleeding or blood clots
• Stiffness of the shoulder
• Nerve injury
• Dislocation
• Prosthesis becoming loose
• Fracture of a bone during insertion of the prosthesis

Outlook Following Surgery

Results following a reverse total shoulder arthroplasty to relieve pain and regain motion are often successful.  With physical therapy, you can expect to recover shoulder function, but you may still have signs of weakness or stiffness in the long-term.

Those who still experience persistent pain after surgery should consider having further investigations for other potential causes of elbow pain to determine if there could be another source to their symptoms.

Need Help?

Private Reverse Total Shoulder Arthroplasty is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.  We also offer a number of other procedures for shoulder and elbow conditions, including shoulder replacement surgery, SLAP repair and elbow release surgery.  We can book you in to see a specialist Orthopaedic shoulder surgeon for an initial consultation, usually within 48 hours.

You can use your private medical insurance or pay for your Reverse Total Shoulder Arthroplasty treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at One Hatfield Hospital.

Why One Hatfield

• Modern purpose-built hospital opened in December 2017
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• Private, spacious, en-suite rooms
• Specialist physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

Contact us and find out more

If you are based in and around Hertfordshire, St Albans, Stevenage, Watford, North London, Welwyn or Bedfordshire and would like to visit the One Hatfield Hospital please click here.