Reverse Shoulder Arthroplasty Surgery in Delhi, India

Surgery becomes an option when severe pain and shoulder weakness significantly affect daily activities. If conservative treatment methods like medication, injections, and physical therapy fail to provide relief, reverse shoulder arthroplasty may be recommended.

It is particularly effective for rotator cuff injuries, which often require a traditional shoulder replacement but can still result in limited mobility. Reverse total shoulder replacement addresses this issue by utilising the deltoid muscle to lift the arm away from the body, restoring functionality.

Reverse shoulder arthroplasty is recommended for individuals with specific shoulder-related issues, including:

• Complex shoulder fractures or dislocations
• Chronic shoulder dislocation
• Tumours affecting the shoulder joint
• Irreparably torn rotator cuff or rotator cuff tear arthropathy
• History of failed shoulder replacement
• Displaced proximal humerus fractures
• Pseudo paralysis (inability to elevate the arm due to underlying reasons)
• Severe cases of rheumatoid arthritis

To be eligible for the procedure, patients should have low functional demand, be physiologically younger than 70 years, possess sufficient glenoid bone stock, and have a fully functional deltoid muscle with an intact axillary nerve.

While reverse shoulder arthroplasty is a beneficial procedure, not all patients are ideal candidates. Some contraindications include:

• Patients with axillary nerve dysfunction (temporary or permanent damage)
• Patients with global deltoid deficiency (partial deficiency may be a relative contraindication)
• Acromion deficiency
• Glenoid osteoporosis
• Active infections (which should be treated before surgery)

Before recommending reverse shoulder arthroplasty, orthopaedic surgeons utilise various imaging techniques to evaluate bone and soft tissue alterations. X-rays and CT scans are commonly employed for preoperative imaging. More advanced procedures, such as 3D scanning, are also utilised to precisely plan the surgery.

To ensure a successful surgery, thorough preparation is crucial. This includes:

• Medical Evaluation

  A comprehensive medical and physical evaluation is conducted before the surgery. Patients with heart disease should also be evaluated by a cardiologist.

• Medications

  Patients must inform their orthopaedic surgeon about any ongoing medications. Certain medications, such as blood thinners, non-steroidal anti-inflammatory drugs, and specific arthritis medications, may need to be stopped before surgery.

• Home Planning

  Simple adjustments at home can facilitate a smoother recovery process. Lowering frequently used belongings and considering hiring a caregiver or staying at a rehabilitation facility can assist with daily tasks during the initial weeks of recovery. Smoking and drinking should be avoided, and adhering to an exercise regime and a balanced diet can aid in a faster recovery.

Before the Surgery

Prior to the surgery, a comprehensive consultation with the surgical team takes place to discuss the patient's medical history, anaesthesia options, and other relevant details.

Surgical Procedure

The reverse shoulder arthroplasty procedure typically takes about 2 hours. The surgeon makes an incision on the front or top of the shoulder to remove the damaged bone and replace it with prosthetic components. The components consist of a metal ball screwed into the shoulder socket and a plastic cup secured into the upper arm bone.

While reverse total shoulder replacement is a highly technical procedure, complications can still arise. These may include bleeding, nerve damage, and infection. Components of the shoulder joint replacement may also experience wear, loosening, or dislocation, requiring revision surgery.

Following the surgery, intravenous antibiotics and pain medications are prescribed. Most patients can resume solid food intake and begin moving the day after the surgery. Discharge usually occurs on the second or third post-operative day, depending on the patient's comfort.

Rehabilitation and precautions post-surgery include following the prescribed home exercise regimen, avoiding sudden and extreme arm or body movements for the first six weeks, refraining from excessive rehab exercises, and avoiding heavy lifting or repetitive movements that strain the shoulder joint.

Reviewed by Dr. Karan Baveja, Consultant, Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury on 02-May-2023.

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