Arthroscopic Balloon Interposition
The arthroscope is connected to a television monitor and the surgeon performs the procedure under video control. The shoulder is thoroughly examined, and the rotator cuff tear is assessed for reparability, if this is not possible then the surgeon proceeds to insert the Inspace Balloon Arthroplasty. A thorough bursectomy and removal of any loose and inflamed tissue is carried out.
The balloon is a biodegradable spacer made out of PLLA (same material as dissolvable sutures) which fully degrades in 6 – 12 months of insertion. The balloon is inserted in a rolled fashion and then inflated with saline. The balloon is then sealed off and the stability is checked before closure of the keyholes.
The balloon acts by reducing the friction between the humeral head and the acromion. It depresses the humeral head and activates the deltoid to take over the main work of the rotator cuff muscles.
At the end of surgery, the wound is closed with dissolvable sutures under the skin. Butterfly stitches, splash proof dressing and a pad is applied, and the arm rested in a sling.
Questions that are often asked
What are the options for massive irreparable cuff tear?
- Inspace Balloon Interposition Arthroplasty
- Superior Capsular Reconstruction (SCR) – this involves inserting an allograft or synthetic graft which is sutured in place of the rotator cuff. The procedure is technically demanding and requires intense rehabilitation after surgery.
Before Admission:
- No food for 6 hours, or drink for 2 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery.
- Please continue to take all your medication as advised by the preassessment team.
What happens on the day of surgery?
You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.
What are the possible complications?
- Complications relating to anaesthesia.
- Infection (< 1 in 1000).
- Stiffness. Mild stiffness is quite common but occasionally a full frozen shoulder can develop (5%) which will prolong your recovery by a few months.
- Pain. This is common for the first few weeks after surgery but steadily settles. Some patients may have some discomfort for 2-3 months post operatively.
- Failure to improve. 80% of patients will make a good or excellent recovery. 15% will have some ongoing discomfort but will be satisfied with their outcome. The procedure can be repeated in select patients.
- Displacement of the balloon may occur in some cases, but its usually partial rather than complete and most patients do well.
What kind of anaesthesia is used?
The procedure is carried out under general anaesthesia and the surgeon will infiltrate the keyholes with local anaesthetic at the end of the procedure.
How long will I be in the hospital?
Almost all patients are able go home the same day of surgery. Occasionally, patients will be admitted for an overnight stay.
After hospital care: Please review the Post-Operative Instructions after Shoulder Arthroscopy
Sling:After your surgery, you will be fitted with a high arm sling, which is for your comfort, you can discard this as soon as you feel comfortable. Most patients find that they use it for between 3 – 4 weeks depending on their pain levels and activity.
Medication: You will be given a prescription for pain medication. Please
start your regular medication as soon as possible after the operation.
At home: Using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist
Removal of stitches & Wound Care: Usually there are no stitches to be removed. You will have a thick dressing over your wound on your shoulder. The ward staff will advise you when and how it should be removed. This is usually changed at 24 – 48 hours after surgery. The butterfly stitches can be inspected by the practice nurse at your GP surgery. You can get into shower after 3 days with the dressings on and leave the wound free to air after 10 days. If any stitches need to be removed, the team will inform you.
Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 – 4 weeks after surgery.
Physiotherapy after my operation
A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department. Rehabilitation typically takes 4 to 6 months and in some cases, may take up to a year.
Return to Work
The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1-2 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 6-8 weeks before you can return. Your doctor and physiotherapist will discuss this with you and advise you accordingly.
Leisure Activities
You should avoid sustained repetitive overhead activities for up to 12 weeks. You can usually start swimming when you are out of the sling – usually 6 to 8 weeks after surgery breast-stroke is advisable initially. Patients generally return to activities such as Golf at about 8 – 12 weeks. For specific guidance regarding sport or DIY please speak to your consultant / therapist.
Driving
When you feel comfortable and have a good range of movement you can begin driving, typically at approximately the 5 – 6 weeks’ post-operative stage, after your sling has been removed. It is advisable to check this with your Doctor or Physiotherapist if you are unsure. It is important to advise your Motor Insurance Company that you have had Shoulder Surgery.
