Reverse the positions of the ball and socket of the shoulder joint.
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Reverse Total Shoulder Replacement
Reverse total shoulder replacement is used in cases of severe arthritis or injuries that have destroyed the shoulder joint. During surgery, the head of the humerus is removed and a metal cup is placed in its place. The glenoid cavity is replaced with a metal ball. This procedure may be beneficial for patients with certain conditions, such as rheumatoid arthritis.
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Reverse total shoulder replacement is a surgical technique for treating rotator cuff tear arthropathy, a condition combining shoulder arthritis and a rotator cuff tear. The shoulder is a ball-and-socket joint where the head of the humerus (upper arm bone) meets the glenoid (shoulder socket). The rotator cuff, composed of four tendons, provides stability and mobility to the joint. A torn rotator cuff can lead to shoulder arthritis.
Conventional total shoulder replacement, which replaces the humeral ball with a metal ball and the glenoid with a plastic socket, is often ineffective for rotator cuff arthropathy because the torn cuff can cause the implants to loosen.
The Reverse Procedure
Reverse total shoulder replacement was developed to address this issue. In this procedure, the placement of the artificial components is reversed: the humeral ball is placed in the glenoid, and the plastic socket is placed on the humerus. This design uses the deltoid muscle to compensate for the torn rotator cuff.
Symptoms and Candidates
Patients with rotator cuff arthropathy may experience pain (often at night) and weakness in the affected shoulder. A common symptom is the inability to raise the arm above the shoulder. Ideal candidates for this surgery include those with a completely torn rotator cuff that is difficult to repair, cuff tear arthropathy, a previous unsuccessful shoulder replacement, severe shoulder pain, or continued pain despite other treatments like rest, medication, injections, and physical therapy.
Procedure and Post-Operative Care
The surgery is performed under general anesthesia. The surgeon makes an incision to expose the joint, removes the arthritic parts of the humeral head and socket, and inserts the artificial metal ball and plastic cup. The joint capsule is stitched, and the wound is closed.
Patients can get out of bed on the same day but typically stay in the hospital for one to two days. Post-operative instructions include:
- Taking all prescribed medications.
- Performing gentle range-of-motion exercises and physical therapy.
- Avoiding overhead activities for at least six weeks.
- Not using shoulder muscles to push oneself out of a chair or bed.
- Avoiding lifting heavy objects.
Risks and Complications
Possible risks include infection, dislocation of the implanted joint, fracture of the humerus or scapula, nerve or blood vessel damage, blood clots, wound irritation, arm length discrepancies, and wearing out of the components.