If you need a shoulder replacement due to severe arthritis combined with a rotator cuff tear, severe arthritis with bone loss and erosion, a completely torn and irreparable rotator cuff, a severe shoulder fracture, or need a revision of a prior shoulder replacement surgery, you may need a reverse shoulder replacement. You are in good hands with the team at Austin Shoulder Institute, in Austin, TX, led by Robert Graham, MD, a board-certified orthopedic surgeon. He has years of expertise in performing reverse shoulder replacement procedures. Call or make an appointment online today.
WHAT IS A REVERSE SHOULDER REPLACEMENT?
Understanding your shoulder joint is helpful when learning about reverse shoulder replacements. Your shoulder joint includes the ball (humeral head) at the top of your humerus (arm bone), scapula (shoulder blade), and clavicle (collarbone). The ball fits into the glenoid (socket) in your scapula and is held in place with your rotator cuff (a network of muscles and tendons), the glenohumeral ligaments, and the large muscles of the shoulder such as the deltoid, bicep, trapezius, and pectoralis major muscles.
During a reverse total shoulder replacement, your surgeon replaces the ball (humeral head) of your upper arm bone with an implant that includes a stem with a curved plastic tray. They replace the socket (glenoid) with a rounded metal head. It’s called a reverse shoulder replacement because the implants reverse the placement of the ball and socket of the shoulder joint. The reversal of the ball and socket allows the stronger deltoid muscles to take over for strength and function.
WHY WOULD I NEED A REVERSE SHOULDER REPLACEMENT?
Dr. Graham recommends shoulder replacement surgery when you have painful, limited arm and shoulder movement that prevents you from sleeping through the night or performing everyday tasks.
Dr. Graham assesses your condition to determine if a shoulder replacement is the best option to relieve your pain and restore your mobility and quality of life. In addition to a physical exam, your surgeon orders X-ray or MRI tests to diagnose arthritis or another chronic problem. This helps determine the best type of shoulder replacement surgery to meet your needs.
It is recommended to have reverse total shoulder replacement when you have:
- Cuff tear arthropathy (shoulder arthritis with a large rotator cuff tear)
- Completely torn and irreparable rotator cuff tendons
- Arthritis with severe joint erosion and bone loss
- A severe shoulder fracture
- A prior shoulder replacement that needs revision surgery
HOW SHOULD I PREPARE FOR SURGERY?
Dr. Graham provides personalized instructions on how to prepare for your shoulder replacement. In general, you will need to fast (avoid eating and drinking) after midnight on the night before your shoulder surgery. You should also wear a loose, button-down shirt to wear after surgery so you don’t need to pull a shirt over your head.
You will have limited mobility in your shoulder following surgery. It is recommended to make sure that all your household chores and self-care needs are either positioned for you to complete with your free arm and/or you can also have a friend or family member there to help you.
WHAT SHOULD I EXPECT AFTER A REVERSE SHOULDER REPLACEMENT?
After your surgery, you are moved to a recovery room and closely monitored as you recover from anesthesia. The surgical team checks your shoulder frequently to assess your movement, temperature, and feeling. In most cases, you’ll recover from anesthesia in one to three hours.
Then, you move to a regular hospital room for further recovery and usually stay in the hospital overnight. Some patients are able to be discharged the same day as surgery. During your stay, you meet with a physical therapist to start the process of rehabilitating your shoulder. You will learn exercises to practice at home.
When you’re discharged from the hospital, your surgeon provides a sling and at-home instructions for aftercare.
Do’s and don’ts after surgery
- Take pain medication and wear the sling as directed
- Attend your prescribed physical therapy sessions
- Don’t use your arm to support your weight or reach for anything
- Practice your at-home physical therapy, but don’t overdo it
- No vigorous physical activity until Dr. Graham says it’s safe
- Arrange for at-home care
HOW LONG DOES IT TAKE TO RECOVER FROM A REVERSE SHOULDER REPLACEMENT?
Everyone recovers at their own rate following orthopedic surgery. There are four phases of rehabilitation and recovery. The first three phases usually take around 12 weeks. The fourth phase focuses on home exercises to continue to improve your strength, flexibility, and range of motion in your shoulder. The fourth phase can last for several months as you return to your pre-injury abilities.
REVERSE SHOULDER REPLACEMENT FAQS
What is reverse shoulder surgery?
It is a type of joint replacement surgery that replaces the ball and socket of your shoulder joint and reverses their positions. The reversal forces your deltoid muscle to provide more support and stability than before surgery.
Why are these surgeries called a “reverse” prosthesis?
Dr. Graham reverses the position of your shoulder joint during this operation. The head of your arm bone is replaced with a prosthetic socket and your socket (glenoid) is replaced with a prosthetic ball.
Why would I need this type of shoulder replacement?
Dr. Graham recommends this type of shoulder arthroplasty for patients that have severe shoulder arthritis with rotator cuff muscles are severely damaged. In addition, reverse replacements are useful when a severe rotator cuff tear can’t be repaired. This type of arthroplasty reduces the stress on your rotator cuff and forces your deltoid muscle to take a more significant role in supporting and stabilizing your joint. Some patients that have severe joint erosion with bone loss also are good candidates for reversed shoulder replacement.
How long does the surgery take?
In most cases, Dr. Graham can complete this operation in one to two hours. However, the total time under anesthesia can be two to three hours.
How painful is this surgery?
The surgery is performed with general anesthesia and a nerve block during your surgery to ensure your comfort. You will have some post-operative pain and stiffness. Dr. Graham prescribes medication for pain relief and physical therapy to help you recover and regain full use of your arm and shoulder.
When can I return to my regular activities?
It usually takes at least four to six months to regain most of your shoulder strength. However, you may need up to a year to get back to your pre-injury strength. Dr. Graham supervises your recovery and physical therapy and will let you know when you can get back to your regular activities.