This is a choice of treatment for shoulder arthritis condition superimposed with rotator cuff injuries. Traditionally there were a lot of surgical treatment options available for shoulder arthritis but sadly none of them could have been applied with rotator cuff tear.
The shoulder is a ball and socket type of joint with more mobility and less stability pertaining to the glenoid cavity of the scapula which is one-fourth of the circular labrum. The strength of the joint is mostly attributed to four muscles called the rotator cuff.
Recommendations of Reverse Shoulder Replacement Surgery:
Shoulder joint like the rest of the joint is exposed to wear and tear gradually leading to shoulder arthritis. Any injury to the joint commonly during sports may be a risk factor for both rotator cuff pathology as well as arthritis.
In the case of earlier shoulder replacement surgeries, the head of the humerus and the glenoid cavity of the scapula is replaced by an artificial joint. If the shoulder joint muscles that provide stability to the joint are torn too, the replacement is likely to lose and malfunction. In some other cases with fracture around shoulder joint or weak bones that may not hold an implant, Reverse Shoulder Replacement Surgery is indicated. This procedure is mostly planned.
- Pain at rest
- Pain during activity
- Restricted activity – Inability to carry out day to day tasks
- Shoulder stiffness
- Pain uncontrolled by drugs or physiotherapy
- Pain uncontrolled by other surgeries
Contraindications for the procedure:
- Nicotine usage – Smoking and other forms of tobacco are associated with higher post-surgical complications. A person willing to get this treatment should well in advance to quit smoking.
- Infections – Any kind of infection anywhere in the body is highly risky. Skin pathologies that might cause infection are contraindicated too.
- Osteoporosis – As stated before osteoporotic bones are unable to hold the prosthesis properly. In some cases, fast-acting cement is used by orthopaedician to fix the implant. Methods to improve bone density can be applied before and after the procedure for it to stay.
- Damage to the scapular part of the joint is a definite contraindication.
- Neural Damage – Damage to brachial plexus or large nerves of the shoulder is contraindication as functions cannot be restored.
- Injury to deltoid muscle – Post surgically deltoid is supposed to take the function of deficient rotator cuff muscles.
- People with dementia, alcoholism, or psychosis are unlikely to follow post-surgical instructions.
- Age and weight as prescribed by your surgeon.
How is reverse shoulder replacement surgery performed?
- General Anesthesia administered after proper marking.
- The incision to access arm bone is made.
- The humerus is examined for any bone spurs, the head is then removed and a socket is created.
- Like traditional joint replacement surgery, there is a prosthetic head and joint space but they are reversely placed to gain the biomechanical advantage of muscles.
- The scapula is then accessed and prepared for placing the head.
- Both prosthetic ends are then fitted to their respective places through a bone cement.
- Joint is established and checked for movements.
- Muscles repaired and incision site closed.
This procedure involves replacing the deficient function of rotator cuff muscles by functional muscle Deltoid.
Post-Surgical Observation is mostly for 2-3 days. Prognosis is excellent, 91% of reverse shoulder replacements last at least 10 years. A complication rate of 15-40% is attached to this procedure too.
- The slackening of the implants – Both the ends may get loose
- instability of the joint – Joint may get dislocated or subluxated
- Insistent pain
- Deep Vein Thrombosis – May lead to pulmonary embolism
- Bone damage during surgery
- Blood vessel or nerve injury during surgery
Cautions to keep:
- Avoid activities that can promote shoulder dislocation like balling hand movement or racquetball.
- Apply intensive physiotherapy for muscle reeducation, deltoid strengthening, and shoulder rehabilitation.
- A healthy intake of calcium and Vit C and D.
- Restricted Joint mobilization.
In minimal cases, re-surgery can be done to alleviate misalignment or dislocation of the prosthetic joint.
This procedure is mostly known for its high-risk high benefit philosophy. Enough data remains unavailable to show the success rate of the procedure but it seems to provide a valid chance for a person suffering from commonly found pathologies, arthritis, and rotator cuff injury when other procedures do not stand a chance.
Dr. Rajesh Verma, Director & Senior Consultant – Orthopaedics, Spine Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi & Narayana Superspeciality Hospital, Gurugram