What is a reverse shoulder replacement?
| Dr Harpreet Singh |
It is a type of shoulder replacement done for patients who have been diagnosed with rotator cuff tear arthropathy. This is a unique form of arthritis affecting only the shoulder joint which develops because of a massive rotator cuff tear that is no longer repairable. These patients have severe pain and are unable to lift their arms even up to the shoulder level (known as pseudo-paralysis). Reverse shoulder replacement allows restoration of overhead function, alleviates pain and gives the patient a pain-free functional shoulder.
Is it a new type of surgical procedure? Are its long term results known?
No it’s not a new type of replacement. It has been used extensively in Europe since 1980s when Paul Grammont introduced the concept of reverse shoulder prosthesis. Many long term studies have proven its efficacy and it has become the standard treatment for cuff tear arthropathy. It got its FDA approval in 2004 and has been used extensively in the US ever since. It was introduced in India in 2011-12.
What are the indications for a reverse shoulder replacement?
Patients with cuff tear arthropathy often have severe pain and disability. Pain is severe at night and often disturbs sleep. Patient are unable to perform activities of daily living like eating, combing, getting dressed because of the severe pain, restriction of motion and diminished strength. Pseudo-paralysis and rotator cuff arthropathy can be seen in older patients with a degenerative massive rotator cuff tear. Other causes of cuff arthropathy include prior failed rotator cuff repairs, or individuals with prior failed shoulder replacement surgery. A reverse shoulder replacement can also be useful in the cases of severe fractures of the proximal humerus (shoulder joint) in older individuals.
In patients with cuff tear arthropathy, an initial trial of physical therapy may be given to try and restore function to acceptable levels. If however significant functional loss and associated pain persist, reverse arthroplasty is the only surgical option.
Why is it called a “reverse” shoulder replacement?
The position of the ball and socket is changed so that the ball is on the socket side of the joint and the socket is on the ball side. In the normal shoulder, the rotator cuff helps the large deltoid muscle to elevate the arm. When the rotator cuff is completely torn and non-functional the humeral head “escapes” superiorly, and the deltoid is then unable to lift the arm by itself. By reversing the position of the ball and socket the loss of the normal rotator cuff is compensated for and the deltoid muscle can then once again raise the arm.
How is the surgery done?
The surgery is done as an in-patient procedure and usually involves a hospital stay of three to four nights. An interscalene nerve block is done to numb the shoulder and arm, and general anesthesia may also be used. An incision is made over the front of the shoulder and all arthritic bone, and any bone spurs, as well as tight scar tissue is removed and a reverse shoulder replacement is implanted.
What is the recovery like?
Physical therapy is initiated during the hospital stay. The patient is taught a simple set of exercises that they can do on their own at home. Typically full recovery is achieved by three to four months post-operatively. A reverse shoulder replacement can significantly decrease pain and improve function for patients and contribute significantly to an improved quality of life.
Why choose Indian Spinal Injuries Center?
The Indian Spinal Injuries Center is a tertiary referral center for complex orthopaedic and joint problems and as such, we are specifically equipped to handle this type of complex operation. Our centre has the distinction of performing the most number of reverse shoulder replacement of any private institute in north India. Our institute has an experienced team of orthopedic surgeons including Dr Deepak Raina, Dr Sumit Khurana and Dr Jayant Kumar, who have been trained in India and abroad in performing this complex surgical procedure. Patients benefit from our multidisciplinary approach to the treatment of shoulder disorders and have access to a full range of care. Our experienced team of physicians, certified physical therapists, and support staff all work together to help patients achieve success. In addition, our affiliated occupational and physical therapists are specially trained in rehabilitation of the shoulder and elbow prior to and after surgical reconstruction.