Reverse shoulder replacement is ideal for patients with cuff tear arthritis and advanced shoulder joint arthritis with significant glenoid wear. Many patients with shoulder arthritis can be managed without surgery; however, when nonoperative treatment has been exhausted surgery is a reliable option to restore function and relieve pain.
The latest advances with 3D planning and printing, computer navigation, and patient-specific instrumentation allow for accurate placement of components leading to improved outcomes for patients.
A reverse shoulder replacement involves replacing the arthritic shoulder joint surfaces with a highly polished metal ball on the socket side (glenoid) and a plastic socket on the arm side (head of the humerus).
Essentially the abnormal surfaces (where the cartilage has worn away resulting in arthritis) are removed and replaced with a prosthesis (artificial joint). The normal anatomical arrangement and biomechanics of the shoulder are reversed – hence this is called a reverse shoulder replacement. The greatest advantage of the reverse shoulder replacement is that it does not require an intact rotator cuff to function; however, it does require a well functioning deltoid muscle.
The decision to have shoulder replacement surgery is unique to each patient. It is a shared decision between you (patient), your family, your local doctor, and your orthopaedic shoulder surgeon.
There are several reasons why you may be a good candidate and be recommended a shoulder replacement:
Computer navigation and 3D planning has revolutionised shoulder replacement surgery. It provides improved accuracy and precision during surgery.
Dr Pant will upload your recent CT scan to a special planning software. Then 3D measurements are taken of your shoulder, the exact wear pattern is analysed, and the correction is planned and the “virtual” prosthesis can be implanted on the computer.
Essentially the shoulder replacement is done on the computer first. Once Dr Pant is happy with the position of the implants, then custom patient-specific instruments are ordered (from the prosthesis company) for the day of surgery. Because the operation has already been done virtually, most of the workflow during the case is more efficient and predictable; surgery time and blood loss is reduced, and the implant position is more accurate and reproducible, leading to better functional results.
There are three essential components to a good outcome from surgery:
Post-operative physiotherapy
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
Therapy overview
After the surgery you will be in a sling and protect your shoulder to allow the shoulder to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.
The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the shoulder begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 12 weeks post Reverse Shoulder Replacement surgery.
Sling
A sling is required for the first 6 weeks after your surgery; the sling is worn for a further 6 weeks outside of the house (to remind others you have had shoulder surgery). The type of sling is selected specific to you and your shoulder surgery:
Driving after shoulder surgery
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
When carried out carefully Shoulder Replacement is a safe and reliable procedure. The Sydney Shoulder Unit revision rates are some of the lowest in the world.
The risk of all complications after a Reverse Shoulder Replacement is 2-3 % in the Sydney Shoulder Unit experience. General risks include:
Specific risks relating to a Reverse Shoulder Replacement
Patients who smoke, use tobacco products, have diabetes, or elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing. Most healthy patients, however, cope well with shoulder replacement surgery and are unlikely to have complications.
The latest advances in computer navigation, 3D planning and printing, and patient-specific instrumentation allow for accurate placement of components resulting in superior radiographic and functional outcomes for our patients.
Sydney Shoulder Unit is a high volume shoulder practice that performs a large number of shoulder replacements each year with consistent outcomes for our patients.
When carried out carefully Reverse Shoulder Replacement is a safe and reliable procedure. The Sydney Shoulder Unit revision rates are some of the lowest in the world.
Australian Orthopaedic Association National Joint Replacement Registry Data (Individual Surgeon Reports) shows that Dr Pant’s revision rate for shoulder replacements is currently 0.00% (as of 2021); the national average is 1.06%. This includes Total Shoulder Replacements, Reverse Shoulder Replacements and Shoulder Replacements for fracture.
Dr Sushil Pant is a leading Australian trained orthopaedic shoulder surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
This lovely 80 year old lady I saw every six months for a few years as she coped with her shoulder pain. We tried injections and therapy for some time. Eventually, she could not manage her pain and lost independence – so we proceeded with surgical treatment.
The plain x-ray shows a standard pattern of arthritis; however, a CT scan and 3D planning revealed things were much worse with significant wear in the shoulder (she had a B2 glenoid with 18 degrees of retroversion and 82% subluxation). Her procedure was planned on the computer with 3D software well before her surgery thus allowing her replacement to be done with precision.
She underwent a successful Reverse Shoulder Replacement with augmentation on the socket side to correct the wear and position the implants accurately.
Her postoperative scan shows a well-aligned prosthesis. She underwent JPL rehab and was very happy with her new shoulder. And I have no doubt she is back to picking olives!
For patients who have no rotator cuff and advanced arthritis, the Reverse Shoulder Replacement has offered new treatment options. Computer 3D planning and Patient Specific Instrumentation has been the latest innovation.
This 81 year old lady underwent a CT scan with 3D planning and computer navigation prior to surgery. This allows for a detailed understanding of the glenoid wear pattern.
A 3D printed patient specific guide is then used to implant the shoulder replacement with a high level of accuracy. In this case the glenoid bone loss (due to wear) was replaced with a custom bone graft using her own humeral head. She completed her rehabilitation using the JPL method and would like her other side done soon.
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Dr Sushil Pant is a leading Australian trained Orthopaedic Shoulder Surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
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