Reverse Shoulder Replacements
A reverse shoulder replacment is one type of operation performed for shoulder arthritis. The normal shoulder can be described as a ball-and-socket joint because one side of the joint is rounded (the humerus) and that moves within a dish-shaped socket (the glenoid). A standard shoulder replacement replaces like-for-like; the ball gets replaced with a rounded piece of metal and the socket with a dish-shaped piece of plastic. A reverse shoulder replacement swaps these around, with the ball being replaced with a dish-shaped socket and vice versa.
This type of shoulder replacement has several advantages over a standard shoulder replacement. It works better and lasts longer if you have torn rotator cuff muscles. Due to its design, it gives more leverage to the muscles that are not torn. It can also be used in situations when you have worn away too much bone to have a standard shoulder operation. Another major use for a reverse shoulder replacement to treat fractures. The main disadvantage is it can result in less movement than a standard shoulder replacement.
Total Shoulder Replacements
A total shoulder replacment may also be called an anatomic shoulder replacement. This is usually performed for shoulder arthritis, a painful condition caused by the smooth cartilage inside your joint wearing out.
The purpose of a shoulder replacement is to remove the damaged parts of the shoulder joint and replace the worn and painful bone ends with artificial surfaces. These are usually made from metal (or ceramic) and plastic.
Find out more about information about total shoulder replacements here.
What does the operation involve?
A reverse shoulder replacement is performed under general anaesthetic, usually with a nerve block that helps with your pain for the first day after surgery. It is performed through a cut in the front of your shoulder, through which the worn bone is removed and the shoulder replacement is inserted.
Mr. Davies routinely performs a navigated shoulder replacement. He is one of the few surgeons in the region to offer this for all of his shoulder replacements. This procedure uses specialised technology that allows him to very accurately place the implants in the correct position. With more accurate placement, it is expected that you will get the best movement, have a lower risk of complications, and the shoulder replacement will last for longer.
The whole procedure takes around 90-120 minutes to complete.
- What are the risks and benefits of this operation?
Before agreeing to this procedure, it is important that you are aware of the risks, as well as its benefits. The main benefit, of course, is to relieve shoulder pain. The risks of all shoulder replacements are:
- Infection: Since a cut is made in the skin, like any cut, it can get infected. An infection in the skin is treated with a course of antibiotics. This usually starts 1-2 weeks after surgery, with the surgical wound looking red and sometimes leaking fluid. Sometimes the infection can go deeper into the bone and joint. This requires further surgery to wash the infection out and, in some cases remove the implants. In this situation, it can require a course of antibiotics for several months before putting the shoulder replacement back. Infections can happen in approximately 1 in 100 shoulder replacements and people with problems with their immune system, or who take medications that reduce your immunity, are at higher risk.We take several measures to reduce the chances of you getting an infection, including using antibiotics at the start of surgery, using antiseptic to clean your skin and performing surgery in a clean environment. It is important to contact your doctor as soon as possible if you shoulder becomes more painful, you feel unwell/feverish, or your wound starts to leak.
- Bleeding: Many techniques are used to minimise blood loss. However, with any surgery, there is always a risk of bleeding or damage to blood vessels that can result in bleeding. This may sometimes require a blood transfusion. It is important to make your doctor aware if you would prefer to avoid a blood transfusion.
- Nerve injury: Nerves are the electrical cables that power the muscles in your arm and give feeling to the skin. Despite taking great care, it is possible to damage nerves in your arm during this procedure. This would result in a loss of movement or strength in part of your arm, or a loss of feeling, most commonly at the top of your arm. It is estimated that around 1-2% of people develop this problem after surgery. It is usually due to the nerve being stretched for part of the operation and for most people, the problem completely recovers afer a few weeks or months.
- Ongoing pain: While shoulder replacements are very successful ways of treating the pain in your shoulder, with more than 90% of people happy with the result, they do not guarantee complete pain relief. Some people do have ongoing pain and if it is particularly troublesome, your doctor will try to look for a cause.
- Stiffness: Most people with shoulder arthritis have limited movement before surgery. Although some people do get more movement after surgery, many people do not. Typically, you can expect to be able to bring your arm to shoulder height, reach the back of your head, and into your back pockets. Remember, the primary aim of a shoulder replacement is to treat the pain. It is important to work hard with the physiotherapists after surgery to get the best result.
- Dislocation: It is possible that your shoulder can come out of joint at any point after surgery. This can sometimes happen if your tendon repair does not heal. It is therefore important to follow your physiotherapist’s advice to ensure that you are giving the tendon a chance to heal without damaging it. An operation is usually required if your shoulder dislocates to put it back in joint. If it dislocated repeatedly, further surgery may be offeret to try to prevent this.
- Loosening and wear: Like any mechanical item, a shoulder replacement can loosen from the bone or wear out over time. If this happens, it can become painful again. You may be offered further revision surgery to put in a new shoulder replacement. Around 90% of shoulder replacements last 10 years.
- Fracture: As part of the operation, it is possible to break the bone, especially if your bone is unusually weak. Furthermore, if you fall at any time after the operation, there is a risk of fracture too. These of course will be treated as required by your surgeon.
- Risks of Anaesthetic: Before your operation, you will have your preop health checkup. Serious problems related to the anaesthetic are very rare (less than 1 in 10,000 for healthy people), but can be serious and sometimes life-threatening. These problems may include heart attack or a stroke, which can affect the movement of any part of your body, speech problems or even blindness. With any surgery, there is also a risk of a blood clot in your leg (DVT / deep vein thrombosis) or lung (PE / pulmonary embolism) and some people are given blood-thinning medications if their risk is higher. Your anaesthetist and surgeon can discuss your own personal risks and the measures they take to keep you as safe as possible throughout surgery.
There are some additional risks of a reverse shoulder replacement:
- Fractured acromion: The wing of the shoulder blade on top of your shoulder is a very important attachment for the powerful deltoid muscle. This is the main muscle that is used to power your shoulder after a reverse replacement. Sometimes, after making a good recovery, you notice an increase in pain at the top of your shoulder. This can be due to a fracture of this part of bone because the muscle is working extra-hard. Often, the pain settles after a few weeks of rest in a sling, but occasionally surgery may be recommended to fix the fracture.
- Deltoid fatigue: Since you are relying on one muscle to work your shoulder, it can stretch over time and stop working as efficiently. For some people, after approximately seven years, they notice a decline in their shoulder function with some aches and pains. Mr. Davies tries not to over-stretch this muscle when he does your operation by carefully positioning the implant. He also uses a particular implant design which does not rely on stretching the muscle so much. Although not proved,
What is the recovery after this surgery?
You will be provided with a sling after surgery, along with instructions from the physiotherapist about how to put on and take off the sling. You may be advised to use the sling for only a few days, or up to four weeks. Most people have little or no pain immediately after surgery due to the nerve block that the anaesthetist puts in. It is vitally important that you start taking painkillers supplied to you before the nerve block wears off so that you keep on top of any pain when the block wears off. Some people also find an ice pack helpful in the first few days. You may also find it more comfortable to sleep slightly propped up. It is advisable to get on your feet and walk around frequently to reduce the risk of blood clots in your legs.
Your physiotherapist will give you some exercises to start. It is important that you do these exercises to prevent stiffness and maximise your chance of a good recovery. Most people are allowed to use their shoulder straight away, within the limits of pain. You will usually be seen in clinic 2-4 weeks after surgery to check that everything is OK. You will notice your shoulder improving over the next few weeks, but it can take several months of work with your physiotherapist to get the full benefit of surgery.
Returning to Normal Activities
You can do most general daily activities as you feel comfortable, such as washing and dressing. Try to keep your dressings clean and dry for the first 10 days, and if they do get wet, dry the area and replace them immediately.
When can I drive?
Most people can return to driving after around 6 weeks or when they feel comfortable. You must not wear a sling to drive.
When can I return to work?
This depends on how heavy your work is. If you work at a desk, this can be as soon as you feel comfortable, perhaps after 2-4 weeks. For heavier jobs, it will take longer. Heavy lifting should be avoided for 3 months. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.
When can I return to sport?
Some sports put more strain on your shoulder than others. Most people return to light exercise in 6 weeks and can then slowly build up to normal activity from there. It is not advisable to return to heavier exercise, overhead sports or contact sports for around 6 months. The key is to listen to your body, don’t overdo it, and build up to normal activities slowly.