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Reverse Geometry Total Shoulder Replacement

Other popular names

Who does it affect?

People suffering with arthritis of the shoulder joint in the presence of a large rotator cuff tear. 

Why is this used?

The reversed shoulder replacement has the ball of the shoulder joint where the socket should be and the socket where the ball usually is in normal anatomy (hence termed ‘reverse’).   The greatest problem experienced by people with this condition is being unable to lift the arm up as the muscles and tendons that normally carry out this function have torn. The design of the reverse geometry shoulder replacemwent allows people who have lost normal function of their shoulder with massive rotator cuff tears or arthritis to return to some of their normal activities without pain.

A normal shoulder replacement usually gives reasonable pain relief for people with cuff arthropathy, but generally does not improve their function. The reversed shoulder replacement changes the mechanics  so that the centre of rotation of the ball and socket (glenohumeral) joint closer to the body and downwards. This increases the length of the deltoid muscle, on the outer aspect of the shoulder (which is not torn), allowing it to work. This muscle is the main muscle that lifts the arm in the air and its function is hence improved by the reversed replacement.

Symptoms

Diagnosis

The diagnosis can usually be made from the history, examination and an X-ray of the shoulder. It is usual for a CT scan to be used to assess the joint and muscles prior to surgery.

Non-surgical treatment

Physiotherapy may be used to reduce inflammation, strengthen the shoulder muscles and to improve the movement in the shoulder.

Therapeutic steroid injections may be used to reduce inflammation and provide pain relief.  These are only performed once or twice and may be done via ultrasound guidance.

Pain-killers and anti-inflammatory drugs will also be offered.  Often pain and weakness is not improved with physiotherapy or injections and at this time you will be offered surgery. 

Surgical treatment

Surgery is carried out under general anaesthetic.

The surgery usually takes between 1-2 hours.

Post-surgery rehabilitation

You will need to stay in hospital 1-2 days.  You will return from theatre wearing a sling. This is usually worn for about four weeks.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The dressing will be removed after 2 days.  The wound is cleaned and redressed with a simple dressing.  The sutures are trimmed at about 12 days. 

Return to normal routine

Keep the wound dry until the stitches are trimmed at 12 days.

Return to driving:

It is advisable to avoid driving until movement in the shoulder has been restored. This is usually a few weeks after the sling is removed. You will be advised about this before your operation.

Return to work:

Everyone has different work environments. You will be given advice on your own particular situation.

Risks

Overall over 97% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).

Specific risks:

http://www.depuy.com/healthcare-professionals/product-details/delta-xtendtrade-reverse-shoulder-system

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