Reverse Shoulder Replacement

Rotator cuff tear arthropathy is a chronic degenerative condition that arises in a shoulder as a result of a significant irreparable tear of the rotator cuff tendons and the development of osteoarthritis of the shoulder joint. This results in pain and stiffness and because of the lack of muscle and tendon the shoulder is usually painful and demonstrates poor function, such that it can prove very difficult to lift the arm.

If the pain and loss of function is significant a reverse shoulder replacement may be considered. Whilst this is primarily used to address the shoulder pain, it can also help restore shoulder function. To help optimise shoulder stability and function the ‘ball’ of the shoulder replacement is secured to the socket side of the joint and the socket of the shoulder replacement is placed on the ball side of the joint. This ‘reversed’ design helps stabilise the shoulder joint and as it also helps to further optimise the function of the deltoid muscle, both pain and shoulder function can be are improved.

In some instances, where there is very advanced disease and bone loss secondary to the rotator cuff tear arthropathy, computer aided surgery may be utilised. In such cases, a CT scan is used to surgically plan your operation in which 3D models and Patient Specific Instrumentation can manufactured. These models and instruments are unique and perfectly match your own shoulder anatomy and can therefore used to further optimise implant placement and thereby outcomes.

Information for patients / operative Information

Risks and complications

• Infection
• Bleeding / haematoma formation
• Nerve injury
• Stiffness
• Residual discomfort
• Loosening
• Dislocation
• Need for later revision

Before admission

• Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr Falworth who organised the investigations.
• No food for 6 hours, or drink for 4 hours, prior to surgery.
• Please avoid smoking for 12 hours prior to surgery

In Hospital

• A reverse shoulder replacement usually requires a hospital stay ranging between 2-4 days.
• A single incision measuring approximately 15ck is made over the front of your shoulder.
• The wound is repaired with dissolving buried sutures and Steri-strips
• Splash proof dressings will be applied but the wound should remain dry for 10 days.
• Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.

What to Expect

• Swelling; immediately after an arthroscopic procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A Cryocuff or alternative cold therapy compress, can be helpful in minimising swelling and inflammation. The Cryocuff will usually be issued to you upon discharge
• Pain; an Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises once the block has worn off, simple oral analgesics can be taken to manage this. These will be provided to you upon discharge.
• Bleeding; there may be some oozing through the bandages but this should settle soon after the operation.

Post-operative care

• A sling will be provided to help rest the shoulder. This should be worn for six weeks to allow for the muscle repairs that were undertaken during the surgery to heal. To prevent the development of undue shoulder stiffness, the belt that is attached to your sling can be removed 24 hours after your operation. However, you may wish to replace it at night whilst in bed.
• The wound should be kept dry for 10 days.
• At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound, if not consult Mr Falworth.
• The most important part of your post-operative care is to start an early exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will maximise the benefit of your operation and will continue as an outpatient.

Post-operative appointments

• You will be reviewed in clinic approximately 3 weeks following your surgery.

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