Shoulder replacements (Total and Reverse)

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Shoulder replacements are used to alleviate pain and restore function for people with arthritis.
Osteoarthritis is a disease which causes pain and loss of normal shoulder movement.
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Normal shoulder.

Operative management

When non-operative methods of treatment fail to provide adequate relief, total shoulder replacement is considered. The primary purpose of the operation is to relieve pain. The secondary aim is to increase your range of motion. The extent of improvement in your range of motion will depend on the severity of your pre-operative condition, the length of time you have had the problem, the range of motion of your shoulder before the surgery and your commitment to the postoperative rehabilitation.

Total shoulder replacement

Total shoulder replacement or shoulder arthroplasty is the replacement of the ball of the upper arm and socket of the shoulder blade with specially designed artificial parts, called prostheses. This replacement can be used if you have arthritis and an intact rotator cuff.
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Narrowed joint space (indicating loss of surface cartilage).
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Anatomic shoulder replacement.

Your operation

The operation involves coming into hospital for 2 to 4 days. Under a general anaesthetic, an incision is made from the shoulder down the front of the arm through which the joint surfaces are surgically replaced. The operation takes approximately two hours.

The ball of the humerus is replaced by a metallic head and stem. The glenoid or scapula is replaced with a polyethylene prosthesis that is cemented into the bone. The surgeon will use the ones that best resemble your bones at the time of surgery. The joint will then be put through a series of movements to make sure it is stable. Your wound is then closed, and you are placed in a sling. You will return to the ward and commence your rehabilitation.

Reverse total shoulder replacement

You may be a candidate for a reverse shoulder replacement if your rotator cuff is torn and you have arthritis. In this replacement we reverse the ball and cup configuration of the shoulder to allow the deltoid muscle to replace the function of the deficient rotator cuff.
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https://orthoinfo.aaos.org/en/treatment/reverse-total- shoulder-replacement/
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Shoulder arthritis with high riding ball due to loss of tendon above shoulder joint.
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Reverse shoulder replacement.
The outcome for reverse shoulder replacements has become much more predictable and with less complications.

Reverse shoulder replacements are also commonly used for shoulder fractures after trauma that are not able to be reconstructed.
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Complications

Complications related to the surgery are rare. Some of the surgical risks include infection, nerve and blood vessel damage, fracture at the time of surgery, dislocation, loosening of the prosthesis, stiffness and ongoing pain. Some of these complications require revision surgery.

A general anaesthetic and a regional pain block are used at the time of surgery and there are risks related to this which your anaesthetist will discuss with you.

Recovery and rehabilitation

You will spend between 2 and 4 days in hospital and then be discharge home or to a rehabilitation hospital if you require ongoing assistance. X-rays and simple blood tests will be done after the surgery.

Physiotherapy will start the day after your surgery and will focus on mobilising your upper limb. The use of a sling will aid in your recovery and can be worn up to 6 weeks after surgery as guided by your surgeon and physiotherapist. Patients are able to return to driving 6 weeks after surgery.
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