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Total Shoulder Replacement or Reverse Shoulder Replacement

Shoulder arthroplasty, often called a total shoulder replacement, is a well-established surgery for treating severe pain and stiffness. In fact, approximately 53,000 people in the U.S. have shoulder replacement surgery each year in order to regain comfort and function, according to the Agency for Healthcare Research and Quality. And while the majority of these procedures would be considered standard replacements, patients may be surprised to know that a “reverse” replacement is also an option. In some situations, a reverse shoulder replacement may benefit a patient more than a standard procedure.

At Beacon Orthopaedics and Sports Medicine, our shoulder specialists have performed numerous total shoulder replacements and reverse shoulder replacements. If you are experiencing shoulder pain and stiffness that limits your activities during the day and keeps you awake at night, you should talk to a specialist about your options. Here is information about total shoulder replacements and reverse shoulder replacements to help guide your discussion.

Q: What is a total shoulder replacement?

In a healthy shoulder, the head of the upper arm bone (humerus) fits into a shallow socket in the scapula. In shoulder replacement surgery the damaged portions of the shoulder are removed and replaced with a smooth metal ball attached to a stem. This artificial component, called a prothesis, will either replace the “ball” of the joint or both the “ball” and “socket.”

Q: What is a reverse shoulder replacement?

In reverse shoulder replacement surgery, the damaged portions of the shoulder are also replaced with a prosthesis made from metal and plastic. However, unlike a standard replacement, the artificial component is placed on the socket side of the joint. The socket is then placed on the arm side where it is supported by a metal stem. Thus, the prosthesis is reverse of where its natural counterparts would be located within the body.

Reverse shoulder replacement works best for patients with cuff tear arthropathy or a detached rotator cuff. The reverse prosthesis allows the patient to use their deltoid muscles instead of their deteriorated or detached rotator cuff tendons in order to lift their arm. It is also effective in people with complex fractures or people who have extensive bone loss.

Q: What are the benefits of shoulder replacement surgery?

First and foremost, the purpose of shoulder surgery is to relieve chronic pain and restore mobility so patients can resume normal living. Additionally, an orthopedic surgeon may recommend a shoulder replacement in order to treat the following conditions:

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Post-traumatic arthritis
  • Rotator Cuff Tear Arthropathy
  • Avascular Necrosis
  • Severe Fractures
  • Bone Tumors

In recent years, advancements in prosthetic designs have allowed patients to resume active lifestyles following surgery. Patients can often return to baseball, golf, swimming, or many of the other activities they enjoy.

Q: How successful is shoulder replacement surgery?

Both total shoulder replacement and reverse shoulder replacement have been shown to be highly effective. As with all forms of surgery, however, the effectiveness of the procedure depends on the overall health of the patient, their participation in physical therapy, and the expertise of the orthopaedic surgeon. Patients can improve their outcomes by choosing an experienced orthopaedic surgeon and adhering to their treatment plan.

Q: What are the potential risks of shoulder surgery?

Shoulder replacements are considered as safe as hip and knee replacement surgeries. Of course, as with any joint replacement surgery, there are associated risks. The most common complication is the dislocation of the prosthesis, with dislocations being more likely to occur among reverse shoulder replacements. Fortunately, a dislocation can be managed by placing the arm back into the proper location and keeping the arm immobile for a period of time.

Shoulder replacement surgery also carries risks associated with other forms of surgery, including:

  • Infection
  • Fracture
  • Nerve or blood vessel damage
  • Joint stiffness or instability
  • Loosening of the prothesis
  • Dislocation

Although rare, other complications may occur. An experienced orthopaedic surgeon can talk to you about these complications and discuss your individual level of risk. In some instances, additional surgery may also be necessary.

Q: How long does it take to recover from shoulder surgery?

For the first 7-14 days following surgery, you will need someone to assist you with your daily activities at home as well as transportation. You should also expect your arm to be in a sling for the first 3-6 weeks and to participate in physical therapy for the first 8-12 weeks.

After about 6 weeks following your surgery, you may resume driving. At this time, you may also return to work depending on how much physical activity is required.

After 1-2 months you may resume lifting heavier objects above the shoulder level.

For most patients, shoulder surgery typically requires 3-6 months for a full recovery.

Q: Who is a candidate for shoulder replacement surgery?

The typical shoulder replacement patient is 50-80 years old. It’s important to note, however, that younger patients may also require surgery. Candidates for total shoulder replacements typically have debilitating, chronic pain or severely restricted joint mobility that interferes with daily activities. And while severe osteoarthritis, rheumatoid arthritis, or another form of the disease are common among patients, shoulder arthritis is not the only condition that may require surgery in order to treat.

Is Shoulder Replacement Appropriate for You?

Every patient’s situation is different and an experienced orthopaedic surgeon whether a total shoulder replacement or reverse shoulder replacement is appropriate for you. If you experience chronic pain and have not achieved relief with conservative, non-surgical treatments, contact Beacon Orthopaedics and Sports Medicine today to schedule an appointment with Dr. Rolf.