This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on any treatment. If you have a problem please consult your doctor or specialist.
When is it offered?
If the investigation shows that you have an extensive arthritis with no muscles to mover the shoulder joint, then ‘reverese’ shoulder replacement is considered. The best example I can give is that compare a shoulder joint to a chariot pulled by 4 horses. If the horses have booted (ie all muscles lost), then the chariot that cannot move normally. If you want to move the chariot, then you need alternative method of pulling. (ie use other mucles that are still left in place to replace the ones that is lost). However, one will have to change the mechanics to make this work. In order to achieve this, a Frenchman (Dr Paul Grammont) conceived the idea of reversing the mother natures design of the shoulder - turn the socket into a ball and the ball into a socket for the first time in 1985!. This simple reversing of the shoulder joint design allowed other intact muscles in the vicinity of the shoulder joint (in particular deltoid muscle) to work differently and the function of shoulder improved and pain decreased.
This rather unusual idea was executed into practice and first results were published in 1993. I became aware of this about 12 years ago and there has been various design changes since the first design. Treatment of shoulder joint without its tendon is challenging. Even I developed a design for shoulder replacement and patented the idea!
I generally do not adopt a new technique quickly. I wait until there is reasonable merits and once I have analysed all the pitfall, the with full information given to the patient, I have carryout the procedure. For example I waited for 5 years after becoming a consultant and nearly 12 years after being made aware of reverse shoulder replacement before I did this procedure on a well deserving patient with success. I do on an average 2 to 3 such operations per year.
The operation is usually performed under general anaesthesia and is usually supplemented with a nerve block injection to minimise the impact of the pain in the immediate post-operative phase. The approach is very similar to the standard shoulder replacement.
The operation is performed with patient lying on their back in a ‘deck-chair’ position. The shoulder joint is approached via 7 to 10 cm cut in the front of the shoulder. As there are not tendons left, entry to the joint is very easy. Appropriate soft tissue releases are done which needs to be a bit more extensive than a standard replacement. .
The socket is now fitted with a ball (glenosphere) and the arm is fitted with a shallow plastic cup mounted on a metal stem inserted inside the bone. The wound is closed with sutures and water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in a sling. You will be given information regarding wound care and information regarding various exercises you need to do. It is important that you are not lifted by anyone hooking the arm under the arm pit.
Reverse shoulder replacement surgery can be more painful than a standard joint replacement surgery during the post-operative phase and the painkillers will only subdue the pain and not fully abolish it. It can take about two weeks for the pain to come under full control.
Physiotherapy will be arranged to recover good function.