Reverse Shoulder Replacement Surgeon
Are you suffering from severe shoulder arthritis? If so, you may be a candidate for a reverse shoulder replacement. Reverse shoulder replacement may be recommended in patients who have developed a complex type of shoulder arthritis called “rotator cuff tear arthropathy.” Reverse shoulder replacement surgeon, Dr. Robert Boykin provides diagnosis and both surgical and nonsurgical treatment options for patients in Asheville who have severe shoulder arthritis. Contact Dr. Boykin’s team today!
What is Shoulder Arthritis?
Shoulder arthritis is a degenerative disease that causes pain, weakness, and limited mobility and function of the shoulder. A common problem among older adults, it often develops from a previous shoulder injury or from the natural aging process of the shoulder joint.
There are many successful non-surgical treatment alternatives to consider for arthritis of the shoulder. Once all non-operative approaches have been tried, replacement surgery can be the next step in helping to alleviate the symptoms. Shoulder surgeon, Dr. Robert Boykin specializes in the treatment of shoulder arthritis for patients in Asheville, Arden, Fletcher and surrounding North Carolina communities.
Am I a Candidate for a Reverse Total Shoulder Replacement?
In patients who have long standing tears of the rotator cuff, the rotator cuff muscles may no longer function as they should. Normally these muscles help to center the ball (humeral head) in the socket (glenoid part of the shoulder blade); however, when they are chronically torn the ball moves higher than the socket which results in arthritis. This process is called rotator cuff arthropathy (wearing of the joint). Because a traditional shoulder replacement approach relies on the rotator cuff muscles to help move the shoulder joint and keep the replacement in proper position, this approach will not be effective in cases of rotator cuff tear arthropathy. Instead, a reverse total shoulder replacement surgery provides the best outcome in terms of pain relief and function.
This special type of replacement changes the biomechanics of the shoulder and allows the deltoid muscle (large muscle on the outside of the shoulder which is not part of the rotator cuff) to to move and stabilize the joint, instead of the rotator cuff muscles. This is accomplished by placing the ball on the glenoid (normally the socket) and the socket on the humerus (which is normally the ball). Because the ball and socket are reversed, the procedure is called a “reverse” total shoulder replacement. Just like with a standard shoulder replacement approach, the degenerated cartilage and bone of the shoulder joint are replaced with metal and plastic components. These components allow patients to have a more mobility, improved function, and less pain.
What is a Reverse Total Shoulder Replacement?
The surgical approach for a reverse total shoulder replacement is the same as that for a standard total shoulder replacement surgery. This involves an incision on the front of the shoulder that allows access into the shoulder joint. The painful degenerative areas of the joint are removed and the metal and plastic components are placed. This procedure is very successful in providing relief for many patients who have had chronic shoulder pain as a result of shoulder arthritis and rotator cuff issues.
Recovery Following Reverse Total Shoulder Replacement
After surgery, it is important for patients to follow rehab closely as this therapeutic process is a very important step in the recovery. After reverse shoulder replacement surgery, patients are placed into a specific therapy program where strength, range of motion, and overall mobility are gained in a stepwise progression. After a recovery period of 2-3 months, patients are typically able to get back to their daily activities and note significant improvements in pain. A return to sporting activities is patient and activity dependent.
Reverse Total Shoulder Arthroplasty FAQ
Why do a reverse total shoulder arthroplasty (replacement)?
Dr. Boykin most commonly recommends a reverse shoulder replacement (also called arthroplasty) in patients who suffer from a complex form of shoulder arthritis known as rotator cuff tear arthropathy. This condition occurs when the rotator cuff muscles that help center the ball in the socket are chronically torn allowing the ball (top of the humerus) to move higher than the socket (glenoid portion of the shoulder blade) and eventually contact the acromion portion of the shoulder blade. In these cases, a traditional shoulder replacement would not work. Other situations that Dr. Boykin may perform a reverse shoulder arthroplasty include certain complex fractures of the shoulder, patients who have significant bone loss or deformity of the socket that does not allow for a standard replacement, or in revision cases.
What is the difference between an anatomic (standard) total shoulder replacement and reverse shoulder replacement?
A standard anatomic total shoulder arthroplasty involved replacing the worn out ball and socket with a new metal ball and high strength plastic socket that matches the patient’s normal anatomy. These replacements rely on the rotator cuff muscles to be functioning to provide power and stability to the shoulder. These are most commonly performed in patients with advanced osteoarthritis or rheumatoid arthritis who have an intact rotator cuff. Unlike a standard shoulder replacement, reverse shoulder replacement surgery relies on the deltoid muscle for stability and mobility. Since the deltoid muscle is rarely torn, it provides a reliable source of power and stability for those patients who have a torn rotator cuff. The reverse replacement involves placing a metal ball where the socket normally is and a plastic socket when the ball normally is (the shoulder is actually reversed). This changes the center of rotation of the shoulder and allows the deltoid muscle to provide power to the shoulder.
How long does it take to recover from reverse shoulder replacement?
After a recovery period of approximately 3 months, patients are typically able to get back to their daily activities and note significant improvements in pain and overall joint function. The reverse shoulder replacement typically does not provide as much range of motion after surgery as a standard shoulder replacement. This involves the design and function of the reverse, which is in many ways a “salvage” procedure to help relieve pain and restore some function to patients with very advanced shoulder problems.
What recovery exercises should I do after a reverse total replacement?
Following reverse shoulder replacement, it is critical patients follow the post-surgery rehab protocol prescribed by Dr. Boykin. Strict adherence to the prescribed physical therapy regimen can help ensure a good outcome. Physical therapy will begin immediately after surgery with a simple set of exercises to be continued at home. The arm is kept in a sling for approximately 5-6 weeks followed by progression of active range of motion then strengthening.
How long does the surgery take and how long is the hospital stay?
A reverse shoulder replacement typically takes around an hour and a half to perform. Some patients may be candidates to go home that same day, however the majority of patients spend one night in the hospital and are discharged the next day.
When can I drive after a reverse shoulder replacement?
Driving is only recommended after patients are completely off pain medications, allowed out of the sling, and have good motion and strengthen in their shoulder. This is usually around 6 weeks after surgery. Until that time assistance will be needed for transportation to therapy visits, etc.
What are my limitations after a reverse shoulder replacement?
For the first 5- weeks patients will remain in the sling with the exception of coming out for elbow range of motion and pendulums initially followed by physical therapy. During this time, they may write and type with the arm but should not drive. After coming out of the sling heavy lifting is avoided until 3 months after surgery. At that point strengthening is advanced and patients are allowed to increase the amount of weight. In general Dr. Boykin recommends not lifting more than 30 lbs. overhead to help improve the life of the replacement. Athletic activities with a high fall risk are limited for the first 6-12 months.
Is a reverse total shoulder replacement painful?
Patients can expect to have pain and discomfort immediately following surgery. Dr. Boykin and the team of anesthesiologists have developed a multimodal approach to post-operative pain control including the use of regional anesthesia (an interscalene block), multiple different types of medications, and the use of cryotherapy (ice) to reduce the amount of pain. After rehabilitation and complete healing, patients have been shown to have significant improvements in their pain after reverse total shoulder replacement.
How successful are reverse total shoulder replacements?
The vast majority of patients are highly satisfied after a reverse shoulder replacement. Most patients have significant improvement in their level of pain in addition to their function. Relief of pain has been shown to be highly predictable while improvements in range of motion and strength have more variability amongst patients and likely has to do with how bad the initial problem is. Many patents can also return to non-contact sports – in fact a recent study found that patients undergoing reverse total shoulder replacement had an 85 percent rate of return to one or more sporting activities, approximately 5 months after surgery with a higher rate of return to sports for patients under 70.
For additional resources on the treatment of osteoarthritis of the shoulder, or to learn more about the reverse total shoulder replacement surgery, please contact the office of Dr. Robert Boykin, serving Asheville, Arden, Fletcher and surrounding North Carolina communities. orthopedic shoulder surgeon.