Reverse Total Shoulder Replacement

What is a reverse total shoulder replacement?

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.

During the surgery, your surgeon
removes the rounded head of the upper arm bone. Using screws and special tools, they
attach 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 the 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.

Healthcare providers suggest
reverse total shoulder replacements for certain types of shoulder injuries. The most
common type is arthritis with a large rotator cuff tear.

Why might I need a reverse total shoulder replacement?

Surgery may be an option for you if you have severe pain that gets in the way of everyday activities. Surgery may also be advised if you have weakness in your shoulder and are not able to move it fully. It may also be advised if your symptoms don’t get better with other treatments. These may include medicines, shots (injections), and physical therapy.

Most people get a standard total
shoulder replacement. But reverse total shoulder replacement works better for people
with large rotator cuff tears. If you have this type of injury, a standard shoulder
replacement still might leave you with some pain and limited movement. A reverse total
shoulder replacement usually improves these problems. After surgery, instead of using
the rotator cuff to lift up your arm, you can use your deltoid muscle. This is a muscle
that helps lift the arm up and away from the body.

Healthcare providers also may advise the surgery to people who have already had a standard shoulder replacement for osteoarthritis or other reasons. These people may still have symptoms that a reverse total shoulder replacement can fix.

How do I get ready for a reverse total shoulder replacement?

Talk with your healthcare provider
about how to prepare for your surgery.

  • Tell your healthcare provider about
    all the medicines you take. This includes over-the-counter medicines such as aspirin
    and all prescription medicines. It also includes herbs, vitamins, and other
    supplements.
  • Ask if you need to stop taking some medicines before the surgery, such as blood thinners.
  • Don’t eat or drink after midnight the night before your surgery.
  • Follow any other instructions from your healthcare provider.

Before your surgery, you may need
imaging tests. These will give your healthcare provider more information about your
shoulder. These might include:

  • X-ray
  • CT scan to see the bones in more detail
  • MRI to see the soft tissue around the bones in more detail

What happens during a reverse total shoulder replacement?

Your healthcare provider can
explain the details of your surgery. An orthopedic surgeon will do the surgery aided by
a team of specialized healthcare providers. The procedure will take several hours. In
general, you can expect the following:

  1. You will likely have general anesthesia. This will make you sleep through the surgery.
  2. You might also get a shot (injection)
    that blocks the nerves in your shoulder and arm. Some people have this instead of
    general anesthesia.
  3. A healthcare provider will carefully check your vital signs during the procedure.
  4. Your surgeon will make a cut through
    the skin near the top of your shoulder. They will also need to cut through the layer
    of muscle beneath.
  5. Your surgeon will remove the damaged
    section of the humerus and the scapula. Using special screws, they will attach the
    metal ball to your scapula and the plastic socket to the top of the upper arm
    bone.
  6. Your surgeon may place a tube to drain extra fluid in the joint. This tube will be taken out later.
  7. After the new joint is in place, your surgeon will close the muscles and skin with stitches or staples.
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