If you suspect you need shoulder replacement surgery because of severe arthritis, you have more than one option.
There’s the standard option, called total shoulder replacement. Or, there is a reverse total shoulder replacement.
A reverse shoulder replacement switches the way your shoulder joint works. This novel approach to shoulder surgery has been around in the U.S. for about 20 years.
It’s helped many people with arthritis and rotator cuff problems, and we perform them right here at UPMC.
But how are the two shoulder replacement procedures different? And, more importantly, which one might be right for you? Let’s explore, starting with, why anyone ever needs a shoulder replacement.
Why Do You Need to Replace Shoulders?
It’s helpful first to understand how shoulder joints work.
Your shoulder is a ball-and-socket joint. The “ball” part of the joint is at the top of your arm bone. It fits into the shoulder socket.
Several strong muscles and tendons, including your rotator cuff, hold everything in place. By design, your shoulder has a wide range of motion. You can reach and move your arm in all directions.
The problem is that conditions like osteoarthritis can eat away at the joint and start limiting that motion. When arthritis gets into the shoulder joint, it causes pain and decreased mobility.
A total shoulder replacement uses artificial parts to give you a new, pain-free shoulder joint.
How Is Total Shoulder Replacement Different From Reverse Shoulder Replacement?
A traditional shoulder replacement recreates your shoulder joint by matching your natural anatomy. The artificial joint has two parts: a metal ball and a plastic cup. The metal ball fits at the top of your arm, and the cup fits in your shoulder socket.
A standard total shoulder replacement allows your shoulder to work as it always has, just with artificial parts.
But with a reverse total shoulder replacement, things are, well, reversed. The ball and socket are switched. The metal ball goes into the socket, and the surgeon fixes the plastic cup at the top of your arm bone.
Swapping the ball and socket location changes the role of your rotator cuff. Remember, the rotator cuff holds the joint in place in a healthy shoulder. This means that a traditional shoulder replacement still needs the rotator cuff to do its job.
But if your rotator cuff is badly torn or damaged reversing how the joint works allows your deltoid muscle to do the job of the rotator cuff instead. Your shoulder muscle essentially takes over.
Reverse total shoulder replacement tends to be better for people who have:
- Unrepairable rotator cuff damage.
- Cuff tear arthropathy (a specific kind of shoulder arthritis).
- Previously had an unsuccessful shoulder replacement.
- A bad shoulder joint fracture or chronic shoulder dislocation.
What to Expect with Reverse Shoulder Replacement Surgery
Reverse total shoulder replacement is major surgery, but with some planning, you can speed your recovery.
The surgery itself takes about two hours. You may go home the same day, but your doctor may also have you spend the night.
You’ll be in a sling when you go home. Your doctor will have you do some light range of motion exercises right away.
It’s important to think about your recovery environment. In the first few days after surgery, it will be difficult to:
- Dress.
- Bathe.
- Cook.
- Do laundry.
- Reach high shelves or cabinets.
Having someone to help you in the days after surgery is crucial. You don’t want to risk injuring yourself or having a complication from the surgery.
Until the doctor clears you for activity, avoid:
- Lifting anything heavier than five pounds.
- Using your arms to push yourself to standing from a chair or bed.
- Reaching your arm behind your back or straight out to the side.
Are There Risks With Shoulder Surgery?
All surgeries come with risks. Your doctor will talk to you about whether you are a good candidate for shoulder surgery.
Some of the risks of reverse total shoulder replacement include:
- Bleeding.
- Nerve damage.
- Infection.
- Wear or loosening of the parts of the artificial joint.
Your care team will do everything they can to reduce these risks.
How Long Does it Take to Recover From Shoulder Replacement Surgery?
Recovery is unique to each person, but most people fully recover within six to twelve months.
Physical therapy (PT) will help you strengthen the shoulder muscle and increase mobility. You can expect to do PT for about three months.
Your physical therapist will guide you through a series of range-of-motion exercises and stretches, including some that you can do at home.
People often ask about limitations after reverse total shoulder replacement. Ideally, you’ll be able to:
- Lift your arm a little over shoulder height.
- Bend your elbow to reach the top of your head.
- Reach above your head. (Most doctors advise that you never lift more than 25 lbs. over your head)
How Effective Is Reverse Total Shoulder Replacement?
At UPMC, we see the difference that reverse total shoulder replacement makes.
The surgery can be life-changing, especially for people who have shoulder arthritis and rotator cuff tears. People go from barely being able to use their arm and managing daily pain to being pain-free.
If you have shoulder pain that’s becoming unmanageable, don’t wait. Learn more about treatments and services at UPMC Orthopaedic Care.
Sources
OrthoInfo. Reverse Total Shoulder Replacement. Link.