The surgery of Reverse Shoulder Replacement (RSR) is advised when the patient’s rotator cuff is torn and there is no alternative method left to treat the condition. In this surgical procedure, the surgeon will replace your shoulder ball with an artificial one made of metal or plastic.
What is a Reverse Total Shoulder Replacement?
This is an arthroplasty procedure for your shoulder joints. Suppose you’re suffering from long-term shoulder pain and having difficulty with movements; in such a case, you should consult with a doctor and see if it is caused by a damaged rotator cuff. Because in such scenarios, you will be required to seek surgical treatment so that your mobility is normal and you won’t face any pain in daily activities.
How to Prepare For a Reverse Shoulder Replacement Surgery in Gurgaon?
When you’re considering Gurgaon hospitals for your shoulder replacement surgery, there are a few things you need to prepare for. Let’s see the checklist for the shoulder’s surgical procedure:
- Consultation and evaluation
Artemis Hospital's orthopaedic surgeon will examine you, review your medical history, and perform imaging tests like X-rays, CT scans, and MRIs to determine the extent of joint damage.
Our medical team will ensure any other conditions, such as anaemia or diabetes, are properly managed before surgery.
Artemis Hospital's anaesthesiologist will meet with you to discuss the anaesthesia plan, which is usually a general anaesthetic in combination with a nerve block for postoperative pain control.
You may be advised to arrange for assistance at home and modify your living space to accommodate your recovery.
What Happens During the Surgical Procedure of Reverse Shoulder Replacement?
Our orthopaedic surgeons will carry out the reverse shoulder replacement by following a step-by-step process. Here, take a look at the steps we take to make sure your shoulder moves normally post-surgery.
- Incision: An incision, about 6 to 15 centimetres long, is made either at the front or top of the shoulder to access the joint. The surgeon carefully moves muscles and nerves, including the deltoid and pectoral muscles, to expose the joint.
- Removal of the humeral head: The damaged, rounded top of the upper arm bone (humeral head) is dislocated and then removed with a surgical saw.
- Humerus preparation: The hollow shaft of the upper arm bone is reamed to prepare it for the stem of the new socket implant. Some systems use bone cement to secure the stem, while others use a "press-fit" cementless design.
- Glenoid preparation: The natural shoulder socket (glenoid) on the shoulder blade (scapula) is reshaped to accept the new prosthetic ball. A metal baseplate is secured to the scapula using screws.
- Implant placement: The prosthetic metal ball, or glenosphere, is attached to the baseplate on the shoulder blade. The prosthetic socket, or humeral cup, is then attached to the stem inserted into the upper arm bone.
- Trial reduction: The surgeon inserts trial components to test the new joint's stability, range of motion, and proper tension before securing the final implants.
- Final implantation: Once the correct sizing and placement are confirmed, the permanent prosthetic components are put into place.
- Wound closure: After the joint is stabilised and a final check is performed, the surgeon closes the muscles and soft tissues with sutures or staples. A drain may be placed to remove excess fluid.
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What Happens After the Shoulder’s Surgical Procedure?
Post the surgical procedure, you will be sent to the recovery room, where the following steps are carried out:
- Immobilisation: Your arm will be placed in a sling for several weeks to protect the joint during the initial healing phase.
- Physical therapy: Gentle exercises will begin shortly after surgery, often while you are still in the hospital. A formal physical therapy programme will continue for several months to regain strength and mobility.
- Gradual recovery: Full recovery can take 6 to 12 months, with pain relief and initial functional improvement noticeable within weeks. Weight-bearing restrictions and limitations on certain movements will be in place for several months.
When Should I Go to the Orthopaedic Specialist For a Reverse Shoulder Replacement Surgery?
You should go to a reverse shoulder arthroplasty doctor for a reverse shoulder replacement surgery evaluation when you have severe, chronic shoulder pain and significant difficulty lifting your arm, especially after non-surgical treatments like physical therapy and injections have failed.
This procedure is typically recommended for complex conditions such as massive, irreparable rotator cuff tears with arthritis (cuff tear arthropathy), a failed previous shoulder replacement, or complex shoulder fractures where the joint's function is compromised and cannot be addressed with a traditional replacement.
A consultation with an orthopaedic surgeon is the best way to determine if you are a suitable candidate and if the potential benefits, including pain relief and restored arm function, outweigh the risks.
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Reverse Shoulder Arthroplasty vs. Total Shoulder Arthroplasty
The two shoulder surgeries, reverse shoulder arthroplasty and total shoulder arthroplasty differ from each other. Take a look at the difference between these two shoulder surgeries below:
Feature | Reverse Shoulder Arthroplasty (RSA) | Total Shoulder Arthroplasty (TSA) |
Joint Design | The ball is placed on the shoulder blade (glenoid), and a socket is placed on the upper arm bone (humerus). | The ball is placed on the upper arm bone (humerus), and a socket is placed on the shoulder blade (glenoid), mimicking natural anatomy. |
Rotator Cuff Dependence | Does not rely on a functioning rotator cuff. Instead, it relies on the deltoid muscle for movement. | Requires a healthy, intact rotator cuff for optimal function and stability. |
Primary Indications | - Massive or irreparable rotator cuff tears
- Rotator cuff tear arthropathy (arthritis with torn cuff)
- Severe glenoid deformity or bone loss
- Failed previous shoulder replacement
- Certain complex shoulder fractures | - Severe osteoarthritis of the shoulder joint with an intact rotator cuff
- Other forms of arthritis (e.g., rheumatoid arthritis) with a healthy rotator cuff
- Avascular necrosis with a healthy rotator cuff |
Motion | - Improves ability to lift the arm (forward elevation).
- Internal and external rotation may be limited compared to TSA. | - Typically results in greater overall range of motion, especially external rotation. |
Strength | Relies on the deltoid muscle for strength, may result in slightly less overall strength compared to a healthy rotator cuff. | Relies on a healthy rotator cuff, which generally results in greater strength and ability to perform higher-demand activities. |
Potential Complications | - Dislocation of the artificial joint
- Scapular notching (grooving of the shoulder blade bone)
- Instability
- Periprosthetic fracture
- Nerve damage (tingling, numbness, weakness) | - Glenoid component loosening or failure
- Rotator cuff tearing
- Instability
- Infection
- Periprosthetic fracture
- Nerve damage |
Reoperation Rates | Studies suggest potentially lower reoperation rates in the mid- to long-term compared to TSA. | Studies show potentially higher reoperation rates compared to RSA, possibly due to glenoid loosening over time. |
Arm Length | May lengthen the arm by 2–3 cm to optimize implant function and stability. | Does not typically lengthen the arm, aiming to recreate the natural joint geometry. |
