BALLOON INTERPOSITION ARTHROPLASTY
This leaflet provides general information to help you understand arthroscopic balloon interposition arthroplasty for an irreparable rotator cuff tear.
A biodegradable balloon spacer eases pain and improves movement, and is usually a day case.
At the heart of my practice is Shared Decision-Making. Whether we pursue conservative management (Plan A) or surgical intervention (Plan B), the goal is to create a tailored treatment plan that aligns with your lifestyle, values, and functional goals.
This leaflet provides general information and does not replace individual medical advice.
The Anatomy of the Shoulder Joint
The shoulder is one of the most complex joints in the body, relying on several structures working together:
How the Shoulder Works
Three main bones form the joint:
- Humerus (upper arm bone)
- Clavicle (collarbone)
- Scapula (shoulder blade)
The Four Key Joints
- Glenohumeral Joint – the main ball-and-socket joint
- Acromioclavicular (AC) Joint – collarbone meets shoulder blade
- Subacromial Space – tunnel above the rotator cuff
- Scapulothoracic Joint – shoulder blade glides over rib cage
The Labrum (Stabilising Ring)
- A rim of rubbery tissue that deepens the shallow shoulder socket — like a "bumper" or suction cup that keeps the joint stable and prevents dislocation.
The Rotator Cuff
Four deep muscles keep the ball centred in the socket and let you lift and rotate your arm:
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
About the Operation
For a massive, irreparable rotator cuff tear, a soft biodegradable balloon (made of PLLA) is placed by keyhole surgery between the ball of the shoulder and the acromion. It cushions the joint, reduces friction and helps re-centre the ball, so the deltoid muscle can move the arm more effectively. The balloon dissolves naturally within 6–12 months, leaving no permanent implant.
Benefits & Logic
The operation aims to:
- Reduce friction between the ball and the acromion
- Help keep the ball better centred in the joint
- Support the deltoid to improve arm movement
The Procedure, Step by Step
The operation, step by step:
- Preparation: the joint is assessed and inflamed tissue removed
- Placement: the rolled balloon is inserted through keyhole portals
- Inflation: it is filled with sterile saline to the right size and sealed
- Closure: dissolvable stitches and a dressing
What Are the Other Options?
InSpace Balloon Interposition
- Provides immediate pain relief
- Improved function
- Degrades naturally within 6–12 months
Superior Capsular Reconstruction or Tendon Transfer
- Uses allograft tissue
- Technically demanding
- Significant post-op rehabilitation
Before, During & After Surgery
Before Surgery
- Fasting: no food for 6 hours, no drinks for 2 hours before
- Smoking: avoid for at least 12 hours before, to aid healing
- Medications: continue as advised by the pre-op team
- Please read 'Preparing for Surgery'
On the Day
- Admission: check in at main reception, then to your room
- Consultation: meet your surgeon and anaesthetist
- Preparation: timing and instructions are reviewed
Anaesthesia
- General anaesthetic with a nerve block that numbs the arm
- Nerve block alone (awake) if general anaesthetic is unsuitable
Recovery & Results
Recovery is a partnership. The timeline below is a guide — your physiotherapist and I will adapt it to you — this shared decision-making process ensures you are fully informed and involved in your care.
Recovery Milestones
- Sling: for comfort in the early weeks
- Gentle exercises: begin immediately
- Recovery: most do well by 6 months, improves to 12 months
- Balloon: dissolves within 6–12 months
Results
Provides pain relief and improved function, especially where a tendon repair is not possible. An alternative for selected patients is superior capsular reconstruction.
After Surgery — In the First Weeks
- Sling: for comfort in the first weeks
- Pain Relief: start at home; take regularly for the first few days
- Wound Care: dressings changed at 24–48 hours; showering after 3–5 days
- Physiotherapy: deltoid-focused rehabilitation is central to recovery
- Follow Up: usually 4–6 weeks after surgery
Watch the Surgery Videos
For more information you can watch procedure videos at: www.youtube.com/c/ProfBijayendraSingh
Watch on YouTubeRisks & Complications
Uncommon, but possible:
- Anaesthetic: complications are rare
- Infection: fewer than 1 in 1000; treated with antibiotics
- Stiffness: mild stiffness is common, improves with physiotherapy (slower with diabetes)
- Pain: common early, settles over the weeks; an injection helps if it persists
- Failure: about 90% do well; a few need further treatment
Return to Activities
This can be extremely variable and discuss with the surgeon. These are just guidelines.
Desk work 1–2 weeks; driving once safe and out of the sling; sport is staged — your physiotherapist will guide the timeline. A member of the team will discuss your specific plan.
Recovery Timeline & Sleeping
⚠ Red Flags — When to Seek Urgent Help
Fever, spreading redness or discharge from the wound, worsening pain, or numbness and a cold hand — seek urgent assessment.
If you experience any of the above, contact the practice, your GP, NHS 111, or attend your nearest Emergency Department.
Key Points to Remember
- A spacer for irreparable cuff tears
- No permanent implant — it dissolves
- Usually a day case
- Deltoid physiotherapy is key to recovery
Questions You May Wish to Ask
- When can I take the sling off?
- When can I drive and return to work?
- How much improvement can I expect?
- What happens if I don't have surgery?
Book or Enquire Directly at Each Site
| LIPS Healthcare London | 0203 870 9996 | singh.admin@lips.org.uk |
| Spire Alexandra Chatham | 01634 662866 | alexandraselfpaypsc@spirehealthcare.com |
| Practice Plus Gillingham | 01634 969045 | Private.gillingham@practiceplusgroup.com |