Reverse Total Shoulder Replacement
Reverse total shoulder replacement is recommended for people who do not have a functioning rotator cuff. For these individuals, an anatomical total shoulder replacement can still leave them with pain and the inability to lift one’s arm past 90 degrees.
The design of the reverse total shoulder replacement is very innovative. As the name implies, the shoulder prosthesis does not recreate normal anatomy, instead the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. Patients receiving a reverse total shoulder replacement have a functioning deltoid muscle, which is the large muscle on the side of the shoulder, and a non-functioning rotator cuff, usually due to a large irreparable rotator cuff tendon tear. This procedure greatly improves the function of the shoulder by absorbing the some of the role of the absent rotator cuff. The prosthesis provides a stable and constant center of rotation, allowing the deltoid muscle to elevate the arm.
While this procedure does not make your shoulder normal, it does improve the function and reduces or eliminates shoulder pain. The prosthesis is non-atomic, but patients can expect to use the shoulder for light activities such as hunting, fishing, playing golf, riding horses, and doing lightweight training exercises in the gym. Most patients are able to drive within three weeks of surgery.
Frequently Asked Questions
Will my arm look the same after surgery?
Because of the design of the prosthesis, the appearance of your shoulder will look slightly different than your non-operative shoulder at the end of your recovery. The normal contour of the deltoid muscle is often diminished. This is because the prosthesis actually lengthens the arm slightly to increase tension in the deltoid to improve its function. Because of this, the bones of the shoulder cap (acromion) and the collarbone (clavicle) sometimes appear more prominent than the opposite shoulder. This is completely normal and expected.
How much assistance will I require postoperatively?
The level of assistance required depends on the general level of medical health and mobility of the patient. Your specific needs will be addressed prior to surgery and immediately after surgery in the hospital. After discharge, most patients manage daily activities with minimal or no assistance. However, patients with greater needs because of decreased mobility or other health issues may require at home assistance from relatives or a home health service. We are accustomed to working with these organizations and arranging care if needed.
When can I exercise after surgery?
Other than the exercises prescribed for your shoulder, no other exercise program should be initiated until at least after your first postoperative visit. Most patients are able to return to lower extremity strengthening exercises, such as riding a stationary bike, within four weeks of surgery.
Is it necessary to donate blood before surgery?
The likelihood of requiring a blood transfusion is less than 5% so we do not require patients to donate blood prior to surgery. However, if you feel strongly that you would not want any blood besides your own should the need arise, it is perfectly reasonable to donate blood preoperatively. This should be done 3-4 weeks before surgery. Our surgery scheduling team can assist you with making the arrangements for auto donation if you choose this option.
Is a cold therapy device recommended?
Most insurance companies do not reimburse for cold therapy device and we do not require patients to use them. They can be helpful in the first 7-10 days postoperatively to decrease swelling and thereby decrease pain and improve function. If a cold therapy device is not purchased, we recommend using ice packs.
Is physical therapy typically prescribed after surgery?
Physical therapy has not been shown to be particularly helpful in the postoperative recovery after reverse total shoulder replacement so it is generally not prescribed.
When to call your physician
It is common to have a low grade fever (100.5 degrees Fahrenheit) for a week after surgery, as well as some blood or fluid around the surgical site, swelling, bruising, and mild numbness. Call The Center at 541-382-3344 if you have any of the following symptoms:
- Fever of 101.5 persists a few days after surgery
- Progressively increasing pain (pain should steadily decrease following surgery)
- Excessive bleeding or fluid coming from surgical site
- Increased swelling and redness around the surgical site
- Persistent nausea and vomiting
- Persistent headache
- Your anesthesia injection site is inflamed (reddened, swollen, or oozes blood or fluid)