Reverse Shoulder Replacement: Impact on Daily Life

What is a Reverse Shoulder Prosthesis?

A reverse shoulder prosthesis is a surgical procedure that replaces a damaged shoulder joint. It differs from a conventional prosthesis because it involves an inversion of the humeral head position and also of the glenoid cavity. This technique is frequently used to treat complex shoulder pathologies such as advanced osteoarthritis, massive rotator cuff tears, and fractures.

Reverse Shoulder Prosthesis: Procedure and Recovery

In preparation for the operation, the surgeon performs radiological examinations to assess the condition of the joint and determine if a reverse shoulder prosthesis is the most appropriate solution. During surgery, the surgeon removes the damaged joint and inserts the prosthesis into the shoulder. After the procedure, a recovery period is essential to allow the shoulder to heal.

Movement Restrictions After Reverse Shoulder Prosthesis

In the initial postoperative stages, it's crucial to avoid certain movements to preserve the integrity of the prosthesis. Generally, it's recommended to limit shoulder flexion, adduction, and internal rotation. The patient may also wear a splint to protect the joint during the recovery period.

Rehabilitation After Reverse Shoulder Prosthesis

To regain satisfactory shoulder mobility after a reverse prosthesis, it's imperative to follow a rehabilitation program. This crucial step can take several months and typically includes exercises focusing on muscle strengthening, stretching, and joint mobilization. The goal is to restore optimal shoulder mobility while avoiding movements that could damage the prosthesis. In short, reverse shoulder prosthesis surgery is an effective treatment for complex shoulder problems. However, recovery and rehabilitation efforts are necessary to restore satisfactory shoulder mobility in the patient, avoiding movements that could damage the prosthesis. If you experience shoulder pain or difficulty, it is recommended to discuss with your doctor to see if a reverse shoulder prosthesis might be a suitable solution for your case.

When is a Reverse Shoulder Prosthesis Indicated?

For individuals suffering from severe rotator cuff injuries, a reverse shoulder prosthesis can offer an effective solution to regain normal shoulder function and muscle strength, as well as improved quality of life. This procedure is also recommended for patients with severe shoulder osteoarthritis where the rotator cuff tendon tissue is highly degenerated and presents a high risk of injury or failure. Over time, this technique has evolved to cover a wider range of problems related to shoulder osteoarthritis.

What is the recovery period after a reverse shoulder prosthesis operation and how does it vary depending on the patient?

Recovery After Reverse Shoulder Prosthesis

Overall, rapid recovery is observed after reverse shoulder prosthesis surgery. If the surgical technique is correctly performed, it is possible to move the limb immediately after the operation. Mobilization can be done independently or with the help of a physiotherapist. Immobilization with a light splint will be used for about 1 month. This will not be absolute immobilization as the splint can be removed 3 to 5 times a day to perform self-managed shoulder mobilization exercises to avoid excessive joint blocking. Healing can be complete by the second month, during which many patients are already able to raise their arm above their head with minimal or no pain. Other patients, however, need longer physiotherapy treatment. This physiotherapy treatment allows for complete recovery, particularly to improve muscle strength and reduce functional compensations.

Does the shoulder return to normal after a reverse shoulder prosthesis operation?

Reverse shoulder prosthesis performed with a correct and well-balanced implant and adequate deltoid muscle functionality allows for recovery considered satisfactory by patients in more than 90-95% of cases depending on the history. However, recovery of active shoulder rotations may be incomplete and also correlated with the possibility of functional compensation by the patient, which is not always predictable. It must be kept in mind that it is not possible to reconstruct the anatomy and functionality of the original rotator cuff tendons with a prosthetic "joint".

Can shoulder function be further improved?

To enhance functional recovery, a complementary surgical procedure has been proposed and approved. The dorsal belt transfer, while increasing the risk of infection and requiring more extensive surgical exposure, is not systematically performed by the majority of highly qualified shoulder surgeons.

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Dos and Don'ts After Reverse Shoulder Prosthesis Surgery?

Meticulously follow the exercise and physiotherapy program prescribed by your orthopedists and physiatrists at the hospital. Avoid extreme arm and shoulder positions, such as behind the body or the right arm to the side for the first 6 weeks.

• Don't overdo it;
• Don't lift anything weighing more than 5 pounds for the first 6 weeks after surgery;
• Don't push yourself up from a chair or bed using your operated shoulder; this involves strong and dangerous muscle contractions;
• Don't lift heavy loads repetitively for the rest of your life after a shoulder replacement;

Can you resume your work or sports activities after a reverse shoulder prosthesis operation?

After the placement of a reverse shoulder prosthesis, heavy and high-impact work should be avoided, as should strenuous sporting activities. All these activities induce a significant direct load on the shoulder joint, increasing stress on the prosthesis and the surrounding bone. This increases the risk of detachment or early mobilization, as well as wear and tear on the special plastic spacer and the shock-absorbing material component, polyethylene.

Why does the reverse shoulder prosthesis have a limited lifespan, and why is it not recommended for young adults?

Once you have completed the rehabilitation protocol, it is highly likely that you will be able to raise your arm just above shoulder height and bend your elbow to reach the top of your head or a cupboard. Over time, however, you can expect to regain excellent mobility that you did not have before the operation. The reverse shoulder prosthesis generally provides exceptional pain relief, and patient satisfaction is very high. The only real problem associated with this specific surgery is the average lifespan of this prosthetic implant, i.e., its longevity, as it is not very high due to its particular design and the very powerful disadvantageous forces to which the prosthetic components are subjected during shoulder movement. Generally, these implants do not last more than 10 years. When these implants fail over time due to wear or mobilization, the revision surgery is much more complex than for other prosthetic implants. This is why this surgical procedure is absolutely not recommended for young adults, and 70 years is the age limit before which this procedure is not offered in our facility.

What are the potential advantages of reverse shoulder replacement?

When a patient shows no improvement following exercises, a shoulder arthroplasty procedure with a prosthesis specifically designed to treat cuff tear arthropathy (CTA) is often considered. This option is often considered for the most advanced cases of this condition. This prosthesis allows arthritic shoulders to regain some of their lost comfort and function. However, when the shoulder is no longer stabilized with the patella in the socket, a reverse shoulder prosthesis (reverse Delta) can be considered. Joint replacement surgery can improve shoulder mechanics but cannot make the joint as good as it was before the onset of rotator cuff tear arthropathy. Successful procedures depend on the individual's overall health and motivation, the condition of the shoulder, and the surgeon's expertise. When performed by an experienced surgeon, reverse shoulder replacement surgery with a prosthesis (also called reverse Delta) can significantly improve shoulder stability and provide improved shoulder comfort and function. The greatest improvements patients experience after reverse shoulder arthroplasty are in their ability to sleep and perform some of the simple activities of daily life. Since the rotator cuff tendons are not repairable in this state, normal shoulder strength and function cannot be regained.

What are the key steps in rehabilitation after reverse shoulder prosthesis surgery?

When you leave the hospital, your arm will be in a sling. Generally, cautious passive mobilization of the shoulder and elbow is immediately given. However, upon discharge you will receive a detailed rehabilitation protocol to follow. You should be able to eat, dress, and take care of your personal hygiene a few weeks after the operation. In addition, upon discharge you will receive instructions to return for follow-up checks every month until you are fully recovered, which will usually be 4 to 5 months after the operation.

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