Orthopedics

OSPI offers the top orthopedic surgeons in Gilbert AZ and the East Valley. Drs. Mahoney, Macqueen, Stewart and Clouse offer minimally invasive General, Sports and Joint Replacement expertise.

Physical Therapy

Whether you are pre or post-operative, OSPI’s East Valley physical therapy team works with you on both active and passive treatments. Your will be in the best hands with our licensed physical therapists!

Chiropractic

The Gilbert chiropractors at OSPI offer a plethora of nonoperative pain relief options such as manipulations, laser therapy, physiotherapy and electrical stimulation.

Family Practice

OSPI offers comprehensive family practice services including allergy testing, BHRT, medical weight loss, aesthetics and full check ups.

Medical Weight Loss

Patients routinely experience dramatic, healthy weight loss with the customized programs at OSPI. The programs combine nutrition, exercise and prescription weight loss options.

Performance Training

OSPI’s integrated team of healthcare providers work with both amateur and professional athletes to maximize one’s performance with sport specific programs.

Pain Management

OSPI’s Board Certified, Fellowship Trained pain doctor offers both medication management and interventional procedures with exceptional outcomes!

Reverse Total Shoulder Arthroplasty

FAQs on Reverse Total Shoulder Arthroplasty in Gilbert, Chandler & Mesa

 

Reverse total shoulder arthroplasty is a new, viable surgical option for patients with irreparable rotator cuff damage caused by shoulder joint arthritis and intricate fractures. First invented in 1980s, the shoulder joint replacement procedure was approved by the FDA for use in the United States in 2003.

What is reverse total shoulder arthroplasty?

Reverse total shoulder arthroplasty refers to a shoulder joint replacement technique that leads to reversal of the ball and socket position in the glenohumeral joint. Devised specifically to treat rotator cuff tear arthropathy, a disorder where shoulder arthritis coexists with large rotator cuff tear.

The procedure reverses the normal arrangement of glenohumeral ball and socket to overcome larger damage to rotator cuff musculature responsible to keep the head of the humerus in the glenoid cavity. A prosthetic socket is attached to the humerus and a hemispherical ball is fixed to the glenoid socket. This reverse shoulder joint arrangement is firmly put in place using screws and bone cement.  

How is it different from total shoulder arthroplasty?

Reverse total shoulder arthroplasty differs from standard total shoulder arthroplasty in just one aspect – it reverse the normal positions of ball and socket in the joint. The new ball implant is placed on the glenoid socket side and the high-strength plastic socket replaces the humeral head.

The underlying cause of the reversal is that total shoulder replacement done for arthritic shoulder is not going to remain fixed successfully because of large rotator cuff tear.

In reverse total shoulder arthroplasty, the deltoid muscle takes up the role of rotator cuff to keep the implants fixed and centered.

What are conditions treated with reverse total shoulder arthroplasty?

Reverse total shoulder replacement is used to treat following conditions.

  • Rotator cuff tear arthropathy or severe arthritis with torn rotator cuff
  • Conditions with major rotator cuff tear and requiring shoulder replacement
  • Humeral fracture requiring shoulder replacement
  • Failed previous total shoulder arthroplasty due to large arthroplasty tear or bone loss

Who is a candidate for reverse total shoulder arthroplasty?

Reverse total shoulder replacement is for

  • arthritis patients with large or completely torn rotator cuff
  • arthritis patients with rotator cuff tear is beyond repair
  • patients with failed previous total shoulder arthroplasty
  • those with severe shoulder pain non-responsive to non-surgical treatments
  • major rotator cuff damage leading to significant dysfunction of shoulder

The primary condition is irreparable rotator cuff tear that prevents any total shoulder replacement procedure. There are four rotator cuff muscles and the procedure is for those with damage to two or of these muscles.

How is reverse total shoulder arthroplasty performed?

The reverse total shoulder arthroplasty is performed under general anesthesia. The procedure uses an anterior approach. An incision is made on the front shoulder. Nerves, muscles, and blood vessels are isolated and moved aside.

Surgeons access the shoulder joint and prepare the upper arm bone and the glenoid for implant. The ball is resurfaced or removed and a hollow is created in the upper humerus. A prosthetic socket is attached to the humerus. A plate is attached to the shoulder blade and a hemispherical ball is fixed to the glenoid socket. This reverse shoulder joint arrangement is firmly put in place using screws and bone cement. The deltoid muscle is restructured to hold the new glenohumeral joint.

How long does reverse total shoulder arthroplasty surgery take?

The surgery takes around 2 hours.

Do I need to stay at the hospital after reverse total shoulder arthroplasty?

The reverse total shoulder arthroplasty is an inpatient surgery and requires at least 2-3 day hospital stay. Pain medication is prescribed to control pain. You are advised to take rest for two weeks.

What are the restrictions following reverse total shoulder arthroplasty?

  • Keep the operated area clean and dry for two weeks
  • Avoid extreme arm positions for 6 weeks
  • Don’t overdo forceful shoulder muscle contractions for 6 weeks
  • Start home exercise program after 2 weeks
  • No lifting for six weeks
  • No weightlifting after shoulder replacement
  • Use a sling for 6 weeks
  • No driving or overhead activities for 6 weeks
  • Do gentle shoulder movements after a week

What kind of rehabilitation is needed following reverse total shoulder arthroplasty?

  • Day 1 to 3 Weeks: Elbow, wrist, and digital motion workouts while wearing the sling, no shoulder AROM, passive range of motions, cryotherapy, activities focused on maintaining integrity of the joint, pain-free deltoid isometrics, avoid shoulder extension.
  • Week 4 to 6: Progressive PROM, minimal resisted elbow, wrist, and hand workouts, cryotherapy, scapular forward flexion and elevation, no shoulder AROM, progressive isometrics, etc.
  • Week 6 to 12: Start shoulder AROM, progressive PROM, dynamic shoulder and scapular stability excercises, scapular forward flexion and elevation, gentle scapulothoracic rhythmic stabilization, strengthening of elbow, wrist, and hand, gentle glenohumeral isometrics, etc.
  • Week 12 to 4 Months: Previous rehab and additional enhanced functional workouts to strengthen shoulder mechanic and muscular endurance. No lifting or pushing.
  • After 4 Months: Continue structural and functional strength gains and your required sports activities within limits.

How long is the recovery period following reverse total shoulder arthroplasty?

Patients feel significant recovery after 6 weeks. Complete recovery takes 6-8 months, but the shoulder strength may not reach the original level though you have significant improvement in pain relief and shoulder motions. Patients are advised to avoid major impact activities or heavy loads for life.

What are the potential complications of reverse total shoulder arthroplasty?

  • Possible early hardware failure
  • Surgical complications that are avoidable
  • Anesthesia complications

References

Mizuno N, et al. Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis in Patients with a Biconcave Glenoid, J Bone Joint Surg Am, 2013 Jul 17; 95 (14): 1297 -1304

Gerber C et al. Reverse Total Shoulder Arthroplasty, J Am Acad Orthop Surg May 2009 vol. 17 no. 5 284-295

Drake G N, et al. Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease. Clin Orthop Relat Res. 2010 Jun; 468(6): 1526–1533.

Smithers CJ, et al. Reverse shoulder arthroplasty. Curr Rev Musculoskelet Med. 2011 Dec; 4(4): 183–190.

Walker M, et al. How reverse shoulder arthroplasty works. Clin Orthop Relat Res. 2011 Sep;469(9):2440-51. doi: 10.1007/s11999-011-1892-0.

Boudreau S, et al. Rehabilitation Following Reverse Total Shoulder Arthroplasty. Journal of orthopaedic & sports physical therapy, December 2007, vol 37 (12), 734-743

Sanchez-Sotelo J. Reverse total shoulder arthroplasty. Clin Anat. 2009;22 (2): 172-82

Ecklund KJ, et al. “Rotator Cuff Tear Arthropathy” J. Am. Acad. Ortho. Surg., June 2007; 15: 340 – 349.

Walker M, Brooks J, Willis M, Frankle M. How reverse shoulder arthroplasty works. Clin Orthop Relat Res. 2011;469(9):2440-2451

Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg. 2011;20(1):146-157

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