If you have ever suffered a stiff shoulder or even a dislocated one, you know how difficult the pain can be. That doesn't even factor in the inability to do a lot of normal everyday tasks while you heal. Now imagine if your shoulder felt like that every day. For many people, this is a reality. Unfortunately, not everybody is a good candidate for traditional shoulder surgery. Fortunately, advances in technology and surgical knowledge have created another solution. An increasing number of patients are undergoing reverse shoulder replacement surgery to regain their mobility and get rid of the pain.
Reasons for Having the Surgery
A doctor might suggest you have a reverse shoulder replacement for several reasons. Most commonly, it is because your rotator cuff has irreparable damage. This can happen due to a sudden injury or because of years of wear and tear. Either way, the rotator cuff will become too weak to move correctly and may even feel paralyzed. By reversing the joint, the rotator cuff has less pressure on it since your arm's movement will depend on the deltoid muscles instead of the rotator cuff. A fractured shoulder may cause the same type of pain as a rotator cuff injury and may also require the surgery. Another common reason surgeons recommend reverse shoulder replacement is because a traditional replacement failed. This may happen if the prosthetics become loose. It is easier for the surgeon to do a reverse replacement than to redo a traditional one in this situation.
People Who Should Avoid a Reverse Shoulder Replacement
Unfortunately, not all patients are good candidates for reverse shoulder replacement surgery. If the socket bone of your shoulder blade is too far gone, it will not be able to hold the screws or base plate that keep the prosthetic in place. However, sometimes the surgeon can perform a bone graft during the surgery which will help to hold the plate and screws in place.
Patients who have an infection in the shoulder on an ongoing basis are also not good candidates for the surgery. The shoulder must first be free of infection, but keep in mind that a once-infected shoulder is more likely to develop a post-operative infection as well.
What Happens During Surgery
Usually, reverse shoulder replacement takes up to three hours to complete, although it is important to note that every patient is different. When you arrive for your surgery, a nurse will take your temperature, check your blood pressure and heart rate, and ensure your oxygen is strong enough for surgery. He or she will also mark the shoulder with a pen so that the doctor knows which shoulder to operate on.
After your nurse prepares you for the procedure, you'll meet the anesthesiologist. In most cases, he or she will provide you with general anesthesia which will put you to sleep. Sometimes the doctor decides to use regional anesthesia. This keeps the area numb when waking up from surgery. Your doctor will help you decide what's right for you before your surgery date.
After the anesthesiologist is done, your surgeon will begin the procedure. He or she will start at top of your shoulder in the front, making a curved incision that is about six inches long. After making the initial incision, your surgeon will cut into deep tissue and a tendon in your rotator cuff so that he or she can get to the joint. When he or she reaches the joint, your surgeon will dislocate your shoulder and examine the humeral neck area. If he or she finds arthritis-related bone spurs at the time, the surgeon removes them with an osteotome. He or she then removes the humeral head.
The next part of the procedure involves getting the humerus bone ready for new socket. This socket is called a humeral cup. He or she will insert a humeral stem, which is a narrow metal shaft that is several inches long and holds the humeral cup in place. The cup is usually polyethylene material. Its smoothness makes movement easier. Your surgeon will shape your shoulder socket to fit the prosthetic. Sometimes he or she uses a cement to hold the prosthetic part to the natural bone; other times, the surgeon uses cementless components. The cement sets in about 10 minutes.
Next, your surgeon secures the humeral cup to the stem and attaches the glenosphere. He or she will select the correct size and shape for prosthetics depending on observation during the procedure. The surgeon may try several components before deciding which ones fit best and permanently securing them into place.
After inserting the prosthetics, your surgeon will check that you can move the shoulder with ease. This involves rotating your arm in various directions. Finally, he or she repairs the soft tissue and stitches or staples the incision back together.
Possible Surgery Complications
Reverse shoulder replacement is not unlike other surgeries in that it may have complications. Some patients find they have issues with the prosthetic parts being misaligned or coming loose after the surgery. In this situation, your surgeon needs to perform a revision surgery. There are several other possible complications as well. Even with antibiotics, almost all surgical procedures carry the risk of an infection. Additionally, because your arm will be immobile during recovery, you run the risk of developing a blood clot. However, compression therapy can help to prevent this problem, and your surgeon may prescribe a mild blood thinner to help. Finally, sometimes a surgery results in damage to the nerves or blood vessels. However, as long as your surgeon is well trained and does his or her job correctly, the risk of this occurring is very low.
What To Expect After Your Surgery
1. Immobile Joints
Your doctors will provide you with a sling to use right after your surgery to keep your shoulder stable. During the first few days, expect to need help with most tasks as your shoulder begins to heal.
Because reverse shoulder replacement is a major surgery, expect to fill a couple of prescriptions. In addition to pain medication, your surgeon will likely give you an antibiotic to ensure the surgery location doesn't become infected. If possible, ask to have the prescriptions filled prior to the surgery so that you don't need to worry about it afterward.
3. Cold Compression Therapy
Your surgeon may ask you to use cold compression therapy, which some feel speeds up the healing process. The cold can reduce pain and swelling while the compression reduces the chance of edema.
4. Rehabilitation Exercises
During the first few weeks, your shoulder will have a limited range of motion. As it heals, your doctor will begin to provide you with rehabilitation exercises. In addition to exercises to do at home, you may also have weekly physical therapy appointments.
5. Follow-Up Appointments
Throughout the recovery process, expect to see your surgeon or doctor at least a couple more times. He or she will want to do follow-up exams and may take x-rays to ensure your shoulder is healing properly. It will take several months for your joint to have a normal range of motion again.
Dos and Don'ts for After Surgery
After surgery, do be sure to follow your doctor's orders exactly. Failure to do so could result in a longer recovery time or even cause your surgery to fail and require a second surgery to fix it. It is also important to avoid any extreme arm positions. Don't put it behind your body or straight out to the side for at least the first six weeks. In addition, avoid lifting anything heavier than five pounds for the first few weeks, avoid using your arm to push yourself out of a seated position and finally, do not do repetitive heavy lifting if you've undergone a reverse shoulder replacement.
Long-Term Outcome of Surgery
The long-term outcome of reverse shoulder replacement surgery varies depending on the patient. Most people can lift their arm to just above shoulder height and bend their elbow after rehabilitation, but they won't likely be throwing a wind-up pitch again. Most patients are happiest with the pain relief after recovering from the surgery. Keep in mind that while early and mid-term studies of the surgery are positive, there are not many long-term studies yet, so it is hard to know what the outcome is after a decade or two.
Finding the Right Surgeon
Reverse shoulder replacement is major surgery and should not be done by the first surgeon you come across. If you decide to have the surgery, speak with your doctor and your insurance to get a list of qualified surgeons in your area. Before scheduling an appointment with one, research to find how long each one has been doing this type of surgery, whether he or she specializes in it or is a general surgeon, and how he or she handles aftercare. You should also verify his or her license and seek out reviews or recommendations to ensure you choose the best surgeon possible to meet your needs.