Reverse Total Shoulder Arthroplasty

Arthroplasty is the replacement or reconstruction of a joint that has been damaged or has degenerated over time, as with arthritis. Glenohumeral osteoarthritis is the wearing out of cartilage in the shoulder joint. People who have severe osteoarthritis of the shoulder joint with accompanying long-term damage of the rotator cuff are candidates for reverse total shoulder arthroplasty.

Since there is damage to the rotator cuff, often resulting in the lack of ability to move lift one’s arm above shoulder height, a traditional shoulder replacement would not be effective. Therefore, a reverse total shoulder arthroplasty is performed, where the positions of the ball and socket components of the shoulder are reversed. This procedure was created by orthopedic surgeons in France.

The ball of the shoulder is replaced with a socket and the socket of the shoulder is replaced with ball. With the reverse total shoulder, a patient will use accessory shoulder muscles, such as the deltoid, to raise the arm in the absence of the rotator cuff. The pain associated with osteoarthritis of the shoulder is greatly reduced with this procedure. Pain associated with osteoarthritis of the shoulder is also greatly reduced, and patients regain significant function of the shoulder. The range of motion is not full after this procedure but it is significantly improved without pain.

Reverse total shoulder arthroplasty involves removing the damaged cartilage that lines the joint and replacing it with a metal implant. In this procedure, the ball of the shoulder is replaced with a metal socket, and the socket of the shoulder is replaced with a metal ball. The implants used are made of titanium or cobalt chrome. They are often cemented in place for additional stability. Patients are often placed in a sling for comfort after surgery. With the reverse total shoulder, you will use accessory shoulder muscles such as the deltoid to raise your arm in the absence of the rotator cuff.

Post Operative Instructions:

SLING/MOVEMENT

  • For the first 7 days after your surgery, you must wear your sling at all times including while you are asleep.  You may only remove the sling to shower and to perform range of motion exercises for your elbow.  You should flex and extend your elbow 3 to 4 times a day to prevent stiffness.

OK to do:

ICE

  • An ice machine will be provided to you prior to your surgery.  This will help decrease swelling and pain after your surgery.  Use the ice machine as much as possible when you get home at intervals of 30 minutes on and off.  You should keep the ice machine for approximately two weeks.  Do not use the ice machine while you are sleeping.

MEDICATIONS

  • Once you are home from the hospital, you can take 600 mg of Ibuprofen (Advil/Motrin) every 6 hours to help with inflammation and pain.  This medication will help cut down the use of narcoticbased pain medication.  However, if you still have pain after taking the Ibuprofen, continue taking the pain medication every 4-6 hours as needed.
  • A sleeping medication (e.g. Ambien) is also provided to help you sleep at night.  Take one tablet 30 minutes before you plan to sleep.

DRESSING/BANDAGES

  • Your shoulder dressing is waterproof.  You may shower the next day after surgery.  Do not remove the dressing; we will do this for you at your 1st post operative visit in the office.
  • Do not take a bath or submerge your shoulder in water until your incisions are checked at your first post-op visit.

DRIVING

  • You may drive  1 week after surgery if you are not taking pain medication.  If your right arm is the operative side, then you must have good control of your arm prior to driving.

APPOINTMENT

  • Please call the office prior to, or immediately following, your surgery in order to schedule a postoperative appointment.  This should be scheduled 7-10 days after surgery.  At that visit you will be given a prescription to begin physical therapy.

If you have any questions or concerns, please contact our assistant at (310) 659-2910 extension 3048.

Download the postoperative instructions for your procedure (PDF) 

Recovery Timeline:

Day of surgery: Arrive one to two hours prior to surgery. Procedure will take approximately one to two hours. Recovery time is one hour. Expect to stay in the hospital for one to two days after surgery. For immediate post-op instructions, download the instruction sheet.

One week post-op: First follow-up visit with Dr. Snibbe/Jennifer. Your stitches will be taken out, and an X-ray will be taken in the office. Continue icing the surgical area two to three times a day (or more if needed). Discontinue the sling as soon as possible to avoid stiffness. Physical therapy will be prescribed. Start physical therapy immediately to work on range of motion.

Four weeks post-op: Second follow-up visit. Range of motion and strength test. Physical therapy will continue to improve range of motion. Mild stiffness is still common. At this point you can start resistance and strengthening exercises.

Eight weeks post-op: Third follow-up visit. Range of motion and strength testing. If additional range of motion or strength training needed, continue physical therapy to work on these. Pain should be mostly resolved at this point.

Twelve weeks post-op: Fourth follow-up visit. Range of motion should be full/normal. You should feel stronger and have very little pain, if any. Near to full recovery is expected at this time.






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