Reverse Shoulder Replacement
In the reverse shoulder replacement, a plastic socket is placed in the upper arm bone and a metal ball is placed in the socket. This effectively allows the deltoid muscle to do the work of the rotator cuff. Patients may not get full range of movements back after reverse total shoulder replacement but get enough movements for functional requirement.
Reverse total shoulder replacement is used for people who have:
- Completely torn rotator cuffs with severe arm weakness
- The effects of severe arthritis and rotator cuff tearing (cuff tear arthropathy)
- Had a previous shoulder replacement that failed
- Fracture of proximal humerus which cannot be repaired in older age group patients
A 14 – 15 cm incision is placed on the front of the shoulder to perform the surgery. A ball is placed on the socket side and a socket in the Humerus (upper arm bone). At the end of the operation the wound is closed with dissolvable sutures which are tied over the skin. Butterfly stitches and a splash proof dressing is applied. A pressure pad is also applied and the arm is placed in a sling.
Questions that are often asked
Why should I have a Reverse Shoulder Arthroplasty / What are the benefits? Of RSA
If your surgeon has diagnosed you with one of the above conditions and there are no other alternatives then a Reverse Shoulder Replacement should be considered.
- The main reason for doing RSA is pain relief and improve function.
- If conservative methods have failed to give you relief of symptoms
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)
- Mild stiffness is quite common but occasionally a full frozen shoulder can develop (5%) which will prolong your recovery by a few months.
- This is common for the first few weeks after surgery but steadily settles. If patients have on going pain after 3 months, this may need further investigations.
- Cracks in bone: Occasionally, small cracks in the bone result in a fracture of one of the shoulder bones during the operation. This can be treated but may slow down your recovery.
- Damageto the nerves or blood vessels controlling the arm and hand. This is usually mild and temporary.
- Dislocation: The new joint may dislocate. This is most likely to happen immediately after the operation and you may need further surgery to treat this.
- Loosening: An artificial joint will usually last between 10 – 20 years, after which it may need to be replaced. This may be needed sooner if there is any complication like infection or the arm is used for heavy manual work
What kind of anaesthesia is used?
A combination of general anesthesia and a nerve block is used for most surgeries. Before the surgery, the anaesthetist will inject numbing medicine around the nerves of the shoulder. This numbs the arm and helps to control your pain after surgery.
How long will I be in the hospital?
Almost all patients are able go home the following day after surgery, some fit patients may be able to go home on the same day. If there are social issues or you feel unwell then the stay may be extended by a day or so.
After hospital care: Please review the Post-Operative Instructions After Surgery
Sling:After your surgery, you will be fitted with a high arm sling, which is for your comfort, and its used for 4 – 6 weeks after the surgery. You will start some exercises immediately after the surgery.
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 10 – 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:The wound is usually closed by dissolvable sutures under the skin which is tied outside the skin and covered with butterfly stitches and sticky plaster dressing and big pad on top of 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 sutures are trimmed at 14 days after surgery which may be done either at GP surgery or nurse at hospital. You can get into shower after 7 days with dressings on.
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 monthsand in often up to a year to get optimum results.
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 2 – 4 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 8 – 12 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 12 weeks after surgery breast-stroke is advisable initially. Patients generally return to activities such as Golf at about 12 – 16weeks. 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 6 – 8 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.
“Do’s and Don’ts” for when you return home:
- Don’t use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.
- Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month.
- Don’t overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.
- Don’t lift anything heavier than a glass of water for the first 6 weeks after surgery.
- Do ask for assistance. Your doctor may be able to recommend an agency or facility if you do not have home support.
- Don’t participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.
- Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 8 weeks after surgery.