What is a reverse total shoulder replacement? 

Reverse total shoulder replacement, also known as reverse total shoulder arthroplasty, is a surgical procedure in which damaged bone and cartilage from your shoulder are replaced with an artificial joint made of metal alloys and high-grade polymers(plastics).  

 

How do I know if I need a reverse total shoulder replacement?

Reverse total shoulder replacement is often recommended after you have failed conservative treatment for arthritis, rotator cuff arthropathy, or injury.  Many daily activities like washing your hair, brushing your teeth, and doing house chores may become painful and difficult to complete.  The recommendation to proceed with surgery is based on a variety of factors including surgeon recommendation, overall health, as well as future expectations and aspirations.  We believe all of your questions and concerns should be addressed before surgery so that you are comfortable with your decision.

 

What are the risks of reverse total shoulder replacement?

Risks of reverse total shoulder replacement include but are not limited to the following: blood clots (DVT/Pulmonary Embolism), bleeding/hematoma, infections which can require additional unplanned operations, fractures, damage to nerves or blood vessels.  Other risks include chronic pain and potential anesthesia complications such as heart, lung, kidney, and liver damage.   

 

How is my surgery scheduled?

If Dr. Wilson has recommended surgery and you have consented to proceed, you will be contacted by one of our surgery schedulers, and a date for your surgery will be set.  The time of day your surgery occurs is based on many factors, and if you have a specific need or request please let them know.  Our surgery schedulers will coordinate insurance authorization, specialist referrals, post-operative physical therapy appointments, as well as follow-up office appointments.  Our surgery scheduler will contact you several days before surgery to inform you what time to arrive for your procedure.  You will be provided instructions on bathing/cleansing measures to perform before your surgery.  DO NOT shave prior to surgery.  If you develop any wounds/sores/cuts/scratches/bites around your surgical site please contact our office 48-72 hours prior to surgery to arrange for evaluation. 

 

What will happen on the day of my surgery? 

You may use the free valet parking if desired, and signage is marked throughout the hospital grounds.  You will present to the outpatient surgery desk on the second floor of the hospital where you will check in.  The receptionist will verify your identification and update any insurance/billing information if necessary.  Following check-in you will be taken back to a private Prep/Recovery room where nursing staff will prepare you for surgery.  Your designated family member may be allowed to accompany you once deemed ready by the nursing staff.  An anesthesiologist will examine you and discuss your medical history, as well as discussing options for pain control including nerve block procedures.  Dr. Wilson and/or his Physician Assistant Adam Barnard will see you before surgery and answer any final questions you may have.  Your family/friends will wait in the outpatient surgery lobby while you are in surgery.  Dr. Wilson will call your designated contact upon completion of the surgery to inform them your procedure is complete.  

 

How long will my surgery take and how long will I be in the hospital?

Your procedure will take approximately 1 hour.  Upon leaving the operating suite you will be taken to the PACU (Post Anesthesia Care Unit) for 1-2 hours before being transported up to your hospital room (typically the 5th floor), or you may be discharged home from the prep/recovery area.  The amount of time you spend in the hospital is based upon many factors.  The majority of patients can be safely discharged home on the same day of surgery.  Occasionally patients will need to spend 1-2 nights in the hospital if medically necessary.

 

How much pain will I have?

Pain is a subjective measure of discomfort that each individual experiences differently.  Pain control requires a multimodal approach including preoperative nerve blocks, intraoperative local anesthesia, and postoperative oral and/or intravenous medications.  If you have an allergy or intolerance to specific medications this should be mentioned before your surgery.  You will be given a prescription for pain medication as outlined in our office policy on prescribing narcotics.  You will be expected to decrease your narcotic use quickly in the postoperative period.  Dr. Wilson will not prescribe any narcotics beyond 8 weeks post-op and if pain control is still problematic a referral to pain management specialists may be required. 

 

How long is my recovery?

Each person recovers from reverse total shoulder replacement uniquely.  It can take up to three months for you to return to a majority of activities, with most patients requiring 6-12 months to obtain maximal strength and endurance.  Your recovery is affected by many factors including dedication with physical therapy, overall condition before surgery and chronic medical problems, and postoperative complications should they occur.   Returning to activities such as driving depends on which shoulder is replaced, what type of vehicle you drive, and one’s comfort and confidence.  In general, you may drive when you are no longer required to wear a sling and have ceased use of narcotic pain medication.   Return to work is based upon your profession and workplace demands.  Someone with a sedentary or office job can often return after 4-6 weeks.  If your profession requires frequent or heavy lifting 4-6 months recovery may be necessary before you can safely resume working.  Traveling is not recommended for at least 2 weeks after surgery, unless it is an emergency.  If traveling is necessary due to an emergency, take frequent breaks and get up to walk around.  Many people experience symptoms of depression and/or anxiety after undergoing a major operation such as total shoulder replacement.  Even those without a history of mental disorders are susceptible to these feelings.  If you have a history of depression/anxiety and worsening of symptoms after surgery please reach out to your primary care provider or mental health specialist to discuss treatment/management.    

 

What else can I do to prepare for surgery?

We ask that you enroll in MyChart prior to surgery in order to provide a more efficient and effective means of communicating with our office.  Our staff will be happy to help you enroll.  You may be required to obtain medical clearance for surgery based upon your past medical history.  This may entail visits with your primary care provider or other specialists (allergist, cardiologist, pulmonologist, endocrinologist, etc.) to ensure you are optimized for surgery.  Several tests such as blood and urine samples, X-ray, CT scan, MRI, and EKG may be necessary.  Your mobility will be decreased after surgery and you may need assistance with daily activities including bathing, cooking, shopping, and laundry.  A social worker, in conjunction with your physical therapist and Dr. Wilson, will help coordinate any needs prior to you leaving the hospital after your surgery.  Preparing your home is important in reducing risk of injury after surgery.  Removing obstacles such as rugs, cords, chairs, and additional clutter is beneficial.  You should clear walking paths throughout your home. Purchasing toiletry, food, and wound care items in advance will reduce your need for travel outside the home.  Please make arrangements for someone to care for your pets if possible.  In addition, animals pose a potential contamination threat to healing surgical wounds.  Making lifestyle changes prior to your surgery can lessen the chance for complications and improve outcomes.  If you smoke, cut down or quit altogether.  Smoking affects blood circulation, delays healing, and slows recovery.  If you drink alcohol, do not consume alcohol for at least 48 hours prior to your surgery.  Major dental procedures and other elective surgical procedures should be postponed  4-6 weeks post-op or until discussed with Dr. Wilson or Adam.  

 

How long will my shoulder replacement last?

Retrospective data demonstrates that more than 95% of reverse total shoulder replacements are still functioning well at 15 years.  Maintaining a healthy and active lifestyle is essential to the longevity of your shoulder replacement.  If you have a history of metal allergies you should let our office know before surgery.  Referral to an allergist may be necessary if you have a history of metal or antibiotic allergies.  The sensitivity of metal detectors varies and it is possible that your prosthesis will cause an alarm to go off.  We no longer provide any “cards” or specific documentation stating you have a joint replacement. 

 

Where can I find additional reliable information about my surgery?

The American Academy of Orthopedic Surgeons has a very informative and easy to navigate webpage including videos about your procedure.  You may visit www.orthoinfo.org