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Reverse Total Shoulder Replacement

This operation is indicated when your rotator cuff is irreparably deficient and this has caused painful arthritis or significant functional problems. Sometimes, a reverse total shoulder is also performed to treat complex proximal humerus fractures.  The operation is generally reserved for patients over 65-70 years of age.

What is involved?

This operation normally involves a 1-2 day stay after surgery.  It is performed under general anaesthetic and regional nerve block.  An incision is made over the front of your shoulder and your damaged joint surfaces are removed.  These are replaced by precision engineered metal and plastic implants.  In a reverse total shoulder, the ball and socket are switched around, so the ball now sits on your shoulder blade and the socket is now on your arm bone.  This 'reversed' arrangement improves the physics in your damaged shoulder to enable better function. 


Reverse geometry total shoulder replacement – see how the ball lies on the scapula and the socket is now on the humerus

What is my recovery after Reverse shoulder replacement?

You will wake up with a sling and your arm will still be numb because of the nerve block. We will help you achieve pain control as your nerve block wears off (12-24hrs).

You will need a shoulder X-ray after your operation to check the implants are OK.  Your physiotherapist will go through your rehabilitation plan with you and most patients can go home by day two after surgery.

Please keep your wound dry and covered with a dressing for two weeks. 

You will come out of your sling between four and six weeks and increase your range of movement exercises from then.  Strengthening will begin at about three months.  

Patients have normally achieved pain relief by three months, but It can take well over a year for you to achieve the full functional benefit of your replacement surgery.

Patients vary in their symptoms after surgery, but in general you can expect to return to:

Office work after three to four weeks (in a sling)

Household daily activities after eight to twelve weeks

Heavier activities may take 16-24 weeks

Driving is allowed once you are confident and competent to control a car both for routine and emergency manoeuvres.  It will probably take eight weeks for you to be ready. 

How long will my shoulder replacement last me?

The ideal joint replacement functions well for the rest of your life.  The younger you are when you have surgery, the greater your chance of your replacement wearing out.  Implant designs and surgical techniques are continuously evolving to optimise both implant longevity and clinical function.  Studies show that 90% of reverse replacements will last 10 years and many will last much longer than this.  Of course, our techniques and implants have moved on from a decade ago, but this remains a good estimate of durability. 

The reverse shoulder replacement relies on your deltoid muscle to move your arm. Recent studies have shown that some patients find that their function begins to deteriorate after 7-10 years.  This is thought to be because this deltoid muscle has been 'over-worked' and is now failing. Again modern implantation techniques and designs are seeking to minimize this issue, but it remains something to consider, particularly if you are young (below 70). 

What can go wrong during shoulder replacement surgery?

Shoulder replacement surgery is major surgery and some patients will suffer complications. Specific risks of reverse shoulder replacement include:

Infection (approx. 2-3%) -  Whilst we undertake every precaution to minimise the risk of infection happening to you, the risk cannot be completely negated. If you develop a deep infection, you may need further surgery, or even removal of your joint replacement, a period on antibiotics and revision surgery.  This is a lengthy and arduous process for the patient and the final outcome is generally less good after an infection.

Stiffness (10%) - Range of motion is never completely normal after a shoulder joint replacement. The aim is for you to be able to raise your arm to, or above shoulder height, but sometimes even this is not achieved. Inwards and/or outwards rotation of your shoulder may remain restricted, but you can normally do your hair and manage personal hygeine. For ladies, you may never be able to reach behind your back to your bra clasp .

Instability (1-2%) -Your joint replacement relies on implant positioning, soft tissue balance and muscle forces for stability.  Very occasionally a replaced joint is unstable. If recurrent, this may require revision surgery

Ongoing pain (5-10%) - Some patients continue to experience pain on certain movements and, occasionally, more constant pain in their shoulder that doesn’t settle down.  A cause for this is not always found

Fracture (1%) - This is rare, but fractures to the socket or your arm bone can happen as your bones are prepared for replacement.  Fractures can often be treated at the same time as your replacement, but they may occasionally prevent completion of your replacement while the fracture heals. If you fall on your arm with a shoulder replacement, your bones may break around the implant and sometimes this causes a well-functioning replacement to loosen and require revision.

Nerve injury (1%) - Important nerves pass close to your shoulder joint. While it is very rare for nerves to be cut, they may get stretched during your operation. The risk of nerve injury is higher if your surgery is happening in a previously-operated region (in revision surgery it can be very hard to identify nerves in scar tissue).  Most nerve injuries recover with time, but permanent muscle weakness in the shoulder or arm could result.

Notching (with modern implants and techniques approx 10%)  - Notching happens when the socket (now on the humerus side) rubs against the shoulder blade.  Over time this causes erosion of the shoulder blade in the form of a visible notch on x-ray.  For the vast majority of patients this notch has no impact on function or pain.  Modern techniques and implant designs have sought to minimize notching and the rate is now much lower. It is rare for notching to cause failure of the replacement.