Reverse Shoulder Replacement

The Shoulder

The shoulder joint is a ball and socket joint. Most shoulder movement occurs where the ball at the top of your arm bone (the humerus) fits into the socket (the glenoid), which is part of the shoulder blade (the scapula).

Why does the joint need replacing?

The most common reason for replacing the shoulder joint is arthritis, either osteoarthritis (wear and tear) or rheumatoid arthritis. It may also be necessary following a fracture or bad accident. With all forms of arthritis the joint becomes painful and difficult to move. Sometimes the deep layer of muscles (the ‘Rotator Cuff’) which help control shoulder movements can also be worn or damaged.

Shoulder replacement

The operation replaces the damaged joint surfaces with a replacement joint (prosthesis). The main reason for performing the operation is to reduce the pain in your shoulder. Hopefully, you may also have more movement in your shoulder. This will depend on how stiff the joint was before the operation and if the muscles around the shoulder are damaged and unable to work normally. There are 2 types of shoulder replacement; anatomic and reversed (see diagrams below). Your options will be discussed at clinic with your Orthopaedic team and are dependent on the condition of your shoulder.

General complications of any shoulder surgery

Pain levels felt after surgery vary depending on the type of surgery, individual pain thresholds, the nature of the problem for which surgery was done and various other factors

Stiffness after shoulder surgery is not uncommon and occurs as a result of pre-existing pathology, surgical scarring and prolonged post-operative protection in a sling. Shoulder movements after shoulder replacement may not completely return to normal even after a successful replacement and the expected range would be discussed with your surgeon, depending on the condition and type of replacement being performed.

Bleeding during or after surgery (less than 1%). It is common to have some oozing from the wound after surgery. It is uncommon to need a blood transfusion after shoulder replacement surgery.

Infection of the wound is rare at less than 0.5%, however early diagnosis of post-operative infection has a significantly better outcome compared to delayed diagnosis. After your operation, you should ring the ward and your GP immediately if you get a temperature, become unwell, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but very occasionally the wound may need to be drained or you may need another operation.

Unsightly scarring of the skin (less than 1%). Most surgical scars have disappeared to a thin pale line by one year after surgery. If you are concerned about your scar you must discuss it with your surgeon or therapist, as there are many treatments to improve scar healing.

Nerve injury is rare with most shoulder operations (less than 0.5%), but some larger operations have a higher risk, such as revision shoulder replacements, and complex fracture surgery.

Vascular injury is again very rare (less than 0.5%) after shoulder surgery. Certain shoulder fractures, previous vascular surgery to the same arm, and revision surgery have a higher risk of vascular injury.

Anaesthetic related complications such as sickness and nausea are relatively common. Heart, lung or neurological problems are much rarer. (Less than 1 person in 1,000).

Complications specific to shoulder replacement

Almost all joint replacements have a limited lifespan. Even though the majority of patients who undergo shoulder replacement do not need a revision operation, it is worth considering loosening and wearing out of the implants; although this is not normally the case for several years after the surgery.

The chances of needing to have the shoulder replacement re-done or revised, are higher and the lifespan of the implant is lower, in patients where there is already bone loss prior to replacement and in younger patients. The lifespan of the implant is also lower in revision surgery

The outcomes and results following revision surgery are, in general, less favourable compared to initial surgery. Similarly complication rates and risks are usually higher in revision surgery.

Dislocation of a shoulder replacement is very uncommon but may need further surgery. Fractures of the bones during or after a shoulder replacement are also very rare, but may need further surgical treatment.

Frequently Asked Questions

Do I need to do exercise ?

Yes. At first, you will only be moving the joint for specific exercises that the Physiotherapist will show you. You will be referred for continued physiotherapy as an outpatient.

Will it be painful?

Although the operation is to relieve pain, it may be several weeks before you begin to feel the benefit. You may have had a local anaesthetic nerve block as part of the anaesthetic so you may wake up with a numb arm. This local anaesthetic will wear off over the first day, so it is important to take medication regularly to begin with to keep the pain under control. You will be given painkillers (either as tablets or injections) to help reduce the discomfort whilst you are in hospital. A one-week prescription for continued pain medication will be given to you for your discharge home. It is important to keep the pain to a minimum by taking regular pain relief, this will enable you to move the shoulder joint and begin the exercises that you will be given by the Physiotherapist. If you require further medication after these are finished, please visit your General Practitioner (GP). You will probably have some bruising and swelling around the shoulder/upper arm. This will gradually disappear over a period of a few weeks. You may find ice packs over the area helpful. Use a packet of frozen peas, placing a damp towel between your skin and the ice pack. Use a waterproof dressing over the wound until it is healed. Leave the ice pack on for up to 20 minutes and you can repeat this several times a day.

Do I need to wear a Sling ?

Yes, your arm will be immobilised in a sling for a period of time. The time and type of sling will vary according to the procedure (see below for the 2 types of sling we may use). This is to protect the surgery during the early phases of healing and to make your arm more comfortable. A Nurse or Physiotherapist will show you how take the sling on and off safely. If you are lying on your back to sleep, you may find placing a thin pillow or rolled towel under your elbow helpful

When do I return to the outpatient clinic?

This is usually arranged for approximately 3 weeks after you are discharged from
hospital, to check on your progress. Please discuss any queries or worries you may have
when you are at the clinic. Appointments are made after this as necessary

How am I likely to progress ?

This can be divided into 3 stages.
1. Sling on, no movement of shoulder except for exercises
You will basically be one-handed immediately after the operation. This will affect your
ability to do everyday activities, especially if your dominant hand is the side of the
operation. Activities that are affected include dressing, shopping, eating, preparing
meals and looking after small children. You will probably need someone else to help you.
You may also find it easier to wear loose shirts and tops with front openings.
2. Regaining everyday movements
When advised, you can gradually wean off using the sling and you will start outpatient
physiotherapy. You will be encouraged to use your arm in front of you, but do not take it
out to the side and twist it backwards. Exercises will help you regain muscle strength
and control in your shoulder as the movement returns. The arm can now be used for
daily activities. Gradually, you can return to light tasks with your arm away from your
body. It may take 6-8 weeks after your operation before you can use your arm above your
shoulder height.
3. Regaining strength with movement
Under guidance, you will be able to increase your activities, using your arm away from
your body and for heavier tasks. You can start doing more vigorous activities, but
contact sports are restricted for at least 4-6 months. This is dependent on the procedure
and should be discussed with your surgical team. You should regain the movement and
strength in your shoulder within 6-8 months. Research has shown that after 2-5 years
about 90 out of 100 people have a stable shoulder with few limitations. Vigorous sports
or those involving overhead throwing may require adaptation for some people, although
many return to their previous levels of activity.

When can I participate in leisure activities?

Your ability to start these will be dependent on the type of stabilizing surgery and on the
range of movement and strength that you have in your shoulder following the operation.
Your surgical team will advise you on exact timescales for your individual procedure.
Start with short sessions involving little effort and gradually increase. General examples
are:
Cycling (road non-competitive) 8-12 weeks
Swimming (breast stroke) 6-8 weeks
Swimming (freestyle) 12-16 weeks
Golf 12-16 weeks
Racquet sports using operated arm 12-16 weeks
Contact sports 4-6 months

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Every member of our team is committed to understanding your condition and guiding you through the right treatment.