Reverse Total Shoulder Replacement
Reverse Total Shoulder Replacement - What is it?
In conventional Total Shoulder Replacement, the normal anatomy of the shoulder joint is copied. A plastic cup is fitted to the shoulder bone to replace the shoulder socket, and to replace the Humerus, or the ball of the upper arm bone, a metal ball is attached to the Humerus. Whereas, in a Reverse Total Shoulder Replacement, also known as Reverse Total Shoulder Arthroplasty (RTSA), the placement of the metal ball and the plastic cup are switched. The plastic cup is fixed to the upper arm bone, and the metal ball is attached to the shoulder bone.
First performed in Europe in 1987, RTSA was approved by the US FDA (Food and Drug Administration) in 2004, the year it was first performed in the USA. Since then, the number of RTSA performed annually has been growing exponentially.
When Should You Get Reverse Total Shoulder Replacement?
An orthopedic surgeon will recommend Reverse Total Shoulder Replacement surgery to patients who have arthritis along with a large cuff defect, also known as Rotator Cuff Tear Arthropathy. However, there are several other conditions that are difficult to treat with conventional total shoulder replacement surgery, and RTSA may be recommended, such as:
- A completely torn Rotator Cuff that cannot be repaired
- Failed shoulder replacement surgery
- Acute fracture of the proximal humerus
- A complex fracture of the shoulder
- Malunited/nonunited proximal humerus fracture
- Tumor of the shoulder joint
- Chronic locked shoulder dislocation
- Chronic pseudoparalysis caused due to irreparable rotator cuff without arthritis
- Immunological arthritis with or without associated rotator cuff tears
- Arthritis of shoulder with severe Glenoid bone loss
- Severe and persistent shoulder pain and difficulty lifting arm
Reverse Total Shoulder Replacement: How to Prepare
Before the surgery, you will have a complete physical examination done by your primary care doctor. You must consult with a specialist if you have any long-standing medical conditions, like heart disease or diabetes. Your surgeon will also ask about the medications you are taking. 2-3 weeks before the surgery, your surgeon might ask you to discontinue taking certain medications, such as blood thinners like aspirin or ibuprofen.
What You Will Experience During Reverse Total Shoulder Replacement
Anesthesia is necessary for RTSA; your anesthetist and surgeon will work with you to explain the type of anesthesia being used. Once the anesthesia kicks in, your surgeon will make an incision on the shoulder. The damaged tissue and bone is removed from the joint, an artificial joint will be inserted to restore the shoulder movement. The entire procedure will last around 2-3 hours.
Recovering from Reverse Total Shoulder Replacement Surgery
After the surgery, you will be administered antibiotics and pain-killers through the IV line to reduce the pain and risk of infection. Most patients stay in the hospital for 1-2 days following the surgery. However, some may go home the same day. The day after the surgery, we find that most patients can get out of bed and eat solid food.
Before you are discharged from the hospital, your arm will be supported by a sling. Your doctor will work with you on some gentle exercises to perform daily, focused on improving blood circulation and healing. Within a few weeks, you'll be back to your daily activities. To aid in regaining the shoulder joint’s strength and flexibility, it will be advised by your doctor to do regular physical therapy.