Reverse Total Shoulder Replacement

The Shoulder joint is a ball and socket joint. The ball or the humeral head is part of the humerus & a socket or a flat surface which is part of the shoulder blade. In a standard shoulder replacement, the ball portion of the shoulder is replaced by a metal implant & the socket by a plastic one.

In a reverse shoulder replacement or reverse prosthesis, the ball is placed on the socket side of the joint. This is reverse of where it is normally located. The socket is then placed on the arm side where is supported by a metal stem in the arm bone. Thus, the ball & socket are reversed and hence the name.

Reverse Shoulder Replacement is often recommended in the following cases:

• Chronic shoulder dislocation
• Tumour of the Shoulder joint
• Unsuccessful shoulder replacement
• Cuff tear arthropathy
• Completely torn rotator cuff that cannot be repaired
• Severe pain in the shoulder & difficulty lifting the arm

A reverse shoulder replacement therapy is often a last resort when rest, medication, cortisone shots and physiotherapy fail to provide relief to the patient.

The risks of this procedure are similar to those of a standard shoulder joint replacement. The most common risk or complication that may occur is that the arm portion or the socket may become dislodged from the shoulder blade part and the prothesis may be dislocated. This is more common in reverse shoulder replacement than in a standard shoulder replacement.

However, it can be managed by placing the arm back into the right place & immobilising it for a certain duration. If the prosthesis continues to dislocate, then further surgery may be required.

Second most common complication is infection. While is rare, it can be of concern. If the infection is chronic despite treatment, then another surgery may be required.

Other complications which are extremely rare but are seen with reverse or regular shoulder replacement are:

• Tingling sensation or numbness
• Injury to blood vessels and
• Blood clots