What is Reverse Total Shoulder Replacement

Reverse total shoulder replacement is a surgical procedure to replace the shoulder joint. You may need this surgery if your rotator cuff is torn and cannot be repaired.

The rotator cuff is a group of muscles and tough, cord-like tissues that connect muscle to bone (tendons) in the shoulder joint. The rotator cuff helps you lift your arm. You may also need a reverse total shoulder replacement if you have:

• A previously unsuccessful normal shoulder replacement.
• Severe pain that keeps you from lifting your arm.
• A severe fracture of your shoulder joint.
• Repeated dislocations of your shoulder joint.
• A tumor in your shoulder joint.

The shoulder is a ball-and-socket joint. The top of the upper arm bone (humerus) is shaped like a ball, and it fits into the socket of the shoulder blade (scapula). During a normal shoulder replacement, a plastic cup replaces the socket, and a metal ball replaces the ball of the humerus. This allows the rotator cuff to lift the arm, like it normally does.

During a reverse total shoulder replacement, the plastic socket is placed into the top of the humerus, and the metal ball is placed into the shoulder socket. This means that the positions of the ball and socket are reversed. This lets you use other shoulder muscles to lift your arm, instead of using the rotator cuff.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures and organs, such as blood vessels or nerves. Nerve damage can cause tingling, weakness, or numbness.
• The ball and socket coming apart (dislocation).
• Shoulder pain.
• Poor return of shoulder movement.
• Loosening of the new shoulder parts over time, which may require replacement.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You may have tests, such as:
  • Blood tests.
  • Chest X-rays.
  • Heart tests.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have someone help around the house for a few weeks after your procedure.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine that helps you relax (sedative).
  • A medicine that makes you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• Small monitors will be put on your body to check your heart, blood pressure, and oxygen level.
• An incision will be made in the front or the top of your shoulder.
• Your shoulder joint will be opened, and the ball of the humerus will be removed from the socket.
• Your shoulder joint will be cleaned out and prepared for the replacement.
• A metal plate will be screwed into your scapula. Then, a metal ball will be screwed onto the plate.
• The plastic socket will be inserted into the top of your humerus and held in place.
• The plastic socket will be positioned onto the metal ball and fixed into place.
• Your incision will be closed with stitches (sutures) or staples.
• Your incision will be covered with a bandage (dressing) or other wound covering.
• Your arm will be put in a sling. This will keep your arm still while it heals.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may continue to receive fluids and medicines, such as pain medicines or antibiotics, through an IV tube.
• You will be shown shoulder exercises to do at home.
• Do not drive for 24 hours if you received a sedative. Ask your health care provider when it is safe for you to drive.

Reverse Total Shoulder Replacement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Stiffness.

Follow these instructions at home:

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Keep the sling clean.
• If the sling is not waterproof, do not let it get wet.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths for bathing.
• If your sling is not waterproof, cover it with a watertight covering when you take a bath or shower.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Driving

• Ask your health care provider when it is safe for you to drive.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do shoulder exercises as told by your health care provider.
• Do not lift your arm above shoulder level until your health care provider approves.
• Do not make large arm movements.
• Do not push or pull things until your health care provider approves.
• Do not lift anything that is heavier than 5 lbs (2.3 kg) until your health care provider approves.

Managing pain, stiffness, and swelling

• If directed, put ice on your shoulder.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers and hand often to avoid stiffness and to lessen swelling.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You feel nauseous or you vomit.
• You are constipated. Constipation is when you have:
  • Fewer bowel movements in a week than normal.
  • Difficulty having a bowel movement.
  • Stools that are dry, hard, or larger than normal.
• Your arm tingles or feels numb.
• Your pain gets worse, even after taking pain medicine.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.

Get help right away if:

• Your shoulder joint moves out of place.
• Your incision comes apart.