Unlike hip or knee replacements, there are two different versions of total shoulder replacements. The first method is an anatomic shoulder replacement, which works under the same idea as a hip or knee replacement: plastic and metal pieces the same shape as the original bone replace the damaged parts of bone. The bone in your upper arm has the ball part of the ball-and-socket joint, while your shoulder blade bone has the socket. You’re eligible for an anatomic shoulder replacement if your rotator cuff is in good shape and you don’t have many deformities in the shoulder joint itself.
The second method is a reverse shoulder replacement, which looks very different from an anatomic shoulder replacement. In a reverse replacement, the ball and socket of the shoulder joint are reversed. In a reverse shoulder replacement, the socket is put on the end of your arm bone and the ball is put on your shoulder blade bone. The deltoid muscle moves the reverse shoulder replacement. Reverse shoulder replacements are good for patients who need shoulder replacements but who do not have good rotator cuffs or who have too many problems with their shoulder itself for an anatomic replacement to be helpful.
When you think about having a shoulder replacement, I see if your rotator cuff is in good shape and if you have bony deformities on the socket. We assess these issues with your X-rays, an in-office exam, and CT scans. I use 3-dimensional reconstructions made from CT scans to help determine how much bone loss or deformity my patients have and how I can best fix that with the reverse shoulder replacement. For example, if a patient has a great deal of bone loss in one place, I can use an implant that is designed to have extra metal in that spot so it can better balance the patient’s shoulder.
Which is better: anatomic replacement or reverse replacement?
One type of replacement isn’t better or preferred over the other type of replacement. The best replacement is the one that is right for your condition. Some patients who have good rotator cuffs and not a lot of deforming do excellent with anatomic replacements. Other patients who have poor rotator cuffs don’t do well with anatomic replacements but can have a reverse replacement. Your surgeon will give you the implant that we think is going to give you the best function and the longest lifespan in your situation. We want to do one shoulder replacement that lasts you 20 years or more and gives you the best functional outcome that you can have, so all the planning that we do preoperatively is aimed at reaching that goal.
Deb’s Story
Deb had two reverse shoulder replacements, one about a year ago and one about eight months ago. She can raise both of her arms in the air above her head, and can place her hands behind her back. I asked her to describe her recovery. “I did not have any trouble with [my recovery],” she says. “In fact, I came into my ten-day after surgery appointment and asked to immediately be scheduled for the next one just four months later. So, I was really pleased with the outcome and I had put it off an awful long time because I was really afraid that it was going to be difficult and very painful.”
Deb had had pain in both of her shoulders for years, had broken one, and had had arthroscopic surgery. After the success of her first reverse shoulder replacement, she “couldn’t get signed up fast enough” for the second replacement. Deb received reverse replacements because of a bad rotator cuff and bad deformity, and it’s difficult to tell that she’s had any kind of replacement.
Warren’s Story
Warren had an anatomic total shoulder replacement about 14 months ago and a reverse shoulder replacement about 2 months ago. He can raise his arms above his head and behind his back. He had very bad arthritic wear and tear on one side but his rotator cuff was in good condition and he didn’t have any major problems with his shoulder socket, so that side was perfect for an anatomic replacement. On his other shoulder, his socket was very worn out in one corner and his joint had somewhat changed shape due to wear, so we did a reverse shoulder replacement on that side.
“I thought both were pretty easy to recover [from],” says Warren. He found it harder to recover his full range of motion on the side with the anatomic replacement compared to the side with the reverse replacement, and he’s working on strength training now.
It’s common for patients to recover more quickly from a reverse replacement than from an anatomic replacement, in part because with a reverse replacement there is no rotator cuff to protect or repair at the end of the surgery. Patients are worried about their range of motion after reverse replacements, but in general it’s much better than what they start with. Additionally, the shoulder replacement will solve the shoulder pain, and pain relief is the real reason to do the shoulder replacement.
Frequently Asked Questions
Can either anatomic or reverse replacements be done as an outpatient surgery?
Yes, both can. We are moving many of our shoulder replacements to outpatient centers for various reasons. One reason is we’ve learned that we can safely and effectively perform the shoulder replacements in surgery center, avoiding an overnight hospital stay. Shoulder replacements don’t involve a great deal of pain. In fact, rotator cuff repairs, which is the other outpatient surgery I do frequently, tend to give patients more pain than shoulder replacements do.
How can a patient prepare as they’re in pain but waiting to have shoulder replacement surgery?
There are several things to prepare before surgeries.
If you take blood thinners, we’ll work with your cardiologist and give you an amount of time to stop the blood thinner before surgery. The exact period of time depends on your specific circumstances and type of blood thinner you’re taking.
I’m a big believer in prehab, or prehabilitation, where you do physical therapy before a surgery to strengthen the muscles so that the outcome is better and your recovery is quicker and easier after surgery.
Weight loss is always a good thing if you’re carrying extra weight. There are body mass index limits for particular surgeries.
What is the recovery time after a shoulder replacement?
Different surgeons will have different rehab protocols. There are 3 phases of recovery from a shoulder replacement. The first phase is using a sling, which for my patients is about 4 weeks for an anatomic replacement and one and a half weeks for a reverse replacement. After an anatomic replacement I want to make sure the subscapularis muscle heals perfectly, since it’s an important muscle for shoulder stability. That muscle is not involved in reverse shoulder replacements, so recovery can be slightly quicker.
The second phase is physical therapy, which is six to eight weeks. The third phase is the rest of the first year post-replacement, getting your strength back. Recovery is at about 10% per month – even though your pain relief and motion may improve quickly, you’re still healing that entire year.
Do patients do physical therapy after a replacement?
Yes, physical therapy after a replacement is important to help strengthen the muscles around the shoulder and to maximize your range of motion.
I tell patients that it’s a 60-40 relationship between surgery and therapy. Sixty percent of how well they do after the replacement is due to how well the surgery is performed and 40% is going to be based on how much work the patient is doing in physical therapy and working to get their motion back.
Is throwing possible after a shoulder replacement?
Throwing is possible within certain ranges. You’re not going to be a professional player, but you can throw a baseball or a football. Most of my patients are golfers or tennis players and they do well after shoulder replacements and reverse shoulder replacements for those sports.