Reverse Total Shoulder Replacement
What is a reverse total shoulder replacement?
A reverse total shoulder replacement is a special type of shoulder surgery. During
the surgery, your surgeon removes the damaged parts of the shoulder and replaces them
with artificial parts.
The shoulder joint is made up of the upper arm bone (humerus) and the shoulder blade
(scapula). The rounded end of the upper arm bone moves inside a shallow socket in
the shoulder blade. Because of this, your shoulder normally has a very wide range
of motion. Cartilage, tendon, and ligaments around the joint also provide support
and help the joint move smoothly.
During the surgery, your surgeon removes the rounded head of the upper arm bone. Using
screws and special tools, they attach a plastic socket to the remaining bone. The
surgeon also removes part of the socket of the shoulder blade. This is then replaced
with a metal ball. The metal ball can then move around inside the socket that attaches
to the upper arm bone.
This is different from a standard total shoulder replacement. In the standard surgery,
the metal ball attaches to the upper part of the humerus. The new socket attaches
to the shoulder blade. This more closely follows a person’s real anatomy.
Healthcare providers suggest reverse total shoulder replacements for certain types
of shoulder injuries. The most common type is arthritis with a large rotator cuff
Why might I need a reverse total shoulder replacement?
Surgery may be an option for you if you have severe pain that gets in the way of everyday
activities. Surgery may also be advised if you have weakness in your shoulder and
are not able to move it fully. It may also be advised if your symptoms don’t get better
with other treatments. These may include medicines, shots (injections), and physical
Most people get a standard total shoulder replacement. But reverse total shoulder
replacement works better for people with large rotator cuff tears. If you have this
type of injury, a standard shoulder replacement still might leave you with some pain
and limited movement. A reverse total shoulder replacement usually improves these
problems. After surgery, instead of using the rotator cuff to lift up your arm, you
can use your deltoid muscle. This is a muscle that helps lift the arm up and away
from the body.
Healthcare providers also may advise the surgery to people who have already had a
standard shoulder replacement for osteoarthritis or other reasons. These people may
still have symptoms that a reverse total shoulder replacement can fix.
What are the risks of a reverse total shoulder replacement?
Every surgery has risks. Risks for this surgery include:
Excess blood loss
Damage to the surrounding nerves (which might limit arm movement)
Break (fracture) of one of the shoulder bones
Dislocation of the artificial joint
Wear or loosening of the artificial parts that would require another surgery
Complications from anesthesia
Some of these risks may be higher in people having a repeat surgery. Your own risks
may vary depending on the anatomy of your shoulder problem and your general health.
Ask your healthcare provider about the risks that most apply to you.
How do I get ready for a reverse total shoulder replacement?
Talk with your healthcare provider about how to prepare for your surgery.
Tell your healthcare provider about all the medicines you take. This includes over-the-counter
medicines such as aspirin and all prescription medicines. It also includes herbs,
vitamins, and other supplements.
Ask if you need to stop taking some medicines before the surgery, such as blood thinners.
Don’t eat or drink after midnight the night before your surgery.
Follow any other instructions from your healthcare provider.
Before your surgery, you may need imaging tests. These will give your healthcare provider
more information about your shoulder. These might include:
What happens during a reverse total shoulder replacement?
Your healthcare provider can explain the details of your surgery. An orthopedic surgeon
will do the surgery aided by a team of specialized healthcare providers. The procedure
will take several hours. In general, you can expect the following:
You will likely have general anesthesia. This will make you sleep through the surgery.
You might also get a shot (injection) that blocks the nerves in your shoulder and
arm. Some people have this instead of general anesthesia.
A healthcare provider will carefully check your vital signs during the procedure.
Your surgeon will make a cut through the skin near the top of your shoulder. They
will also need to cut through the layer of muscle beneath.
Your surgeon will remove the damaged section of the humerus and the scapula. Using
special screws, they will attach the metal ball to your scapula and the plastic socket
to the top of the upper arm bone.
Your surgeon may place a tube to drain extra fluid in the joint. This tube will be
taken out later.
After the new joint is in place, your surgeon will close the muscles and skin with
stitches or staples.
What happens after a reverse total shoulder replacement?
Ask your healthcare provider about what you should expect after your surgery. In general,
after your operation:
Your operated arm may be numb from the anesthesia. You also may not be able to move
your hands or fingers. This will last for several hours.
You may have some pain, but pain medicines should help as needed.
You might use a device to keep ice on your shoulder.
You’ll probably need follow-up X-rays to make sure your surgery was successful.
Your arm will probably be in a sling after the surgery for several weeks.
You will probably begin physical therapy exercises while you are still in the hospital.
You should be able to have a normal diet as soon as you can handle it.
You may need to stay in the hospital for 2 to 3 days.
You’ll have some pain as you heal after the surgery. But your original shoulder pain
should be improved.
Follow all your healthcare provider’s instructions about caring for your shoulder
and wound. This might include continued icing of your shoulder and physical therapy.
A little bit of drainage from the wound is normal. But let your healthcare provider
know if it continues to swell and bleed, or if you have a fever or chills.
Your healthcare provider can let you know when you will be able to use your hand and
arm more fully. You will probably be able to use your wrist and hand soon after your
surgery. You won’t be able to use your arm for several weeks, though. Most people
can return to light work within a few weeks.
Make sure to keep all your follow-up appointments with your healthcare provider. Keeping
in close touch with them can help you have the best possible outcome. Most joints
will last several years before they will need to be replaced.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure