Reverse Polarity Total Shoulder Replacement
Reverse polarity total shoulder replacement (rp-TSR) is an operation to treat arthritis of the shoulder with pain, associated with massive irreparable tears in the tendons (rotator cuff) around the shoulder. It is reserved as a last resort as though in the majority of cases they function well, the complications are serious if encountered. For this operation to work the deltoid muscle must be functioning as it alone allows the new shoulder replacement to function. In addition, because there are limited options after reverse shoulder replacement we tend not to offer this surgery in younger patients (<65 years) but these rules are flexible to some extent. If you are young with a massive irreparable rotator cuff tear, there are other options available to you.
You will normally be admitted on the day of surgery unless you have any specific medical complaints that require prior admission. You will be seen by a nurse, a doctor and maybe a physiotherapy before you go to theatre for your surgery; you will have opportunity to ask any further questions prior to the operation. The anaesthetic time and operation lasts around 2-3 hours. You will be asleep under general anaesthetic and may also have a nerve block to control your pain after the surgery.
During the operation we replace the diseased and painful parts of your shoulder (ball-and-socket) joint. It is called REVERSE shoulder replacement because we exchange the ball for a socket made of hard plastic, and the socket for a metal ball. This serves to position the shoulder joint slightly lower than it was before allowing the deltoid muscle to elevate the arm up towards shoulder height without pain.
On the morning following surgery you will have an x-ray of the shoulder to check for any fractures we may have caused but not noticed and that the new shoulder is in the correct position. During the x-ray your arm may be moved; do not worry these are the views we need to get to ensure the images are accurate. We will look at the x-rays before your discharge. You may require blood tests after your surgery, though this is not always the case. The physiotherapists will arrange followup and tell you what you can and can’t do with your shoulder. Most people will go home on the first day following surgery but we will never discharge you until you’re safe.
The general complications include bleeding, infection, stiffness and ongoing pain.
Specific complications with this procedure include:
- dislocation of or fracture around the new shoulder prosthesis
- nerve injury (2% but most recover fully)
- loosening of the prosthesis requiring further surgery
There are no long-term outcome studies looking at rp-TSR, though early results are promising. Especially in comparison to hemiarthroplasty (half joint replacement of the ball only) for either rotator cuff disease or unreconstructable fractures of the shoulder. We try to perform outcome scores at 3 months, 6 months, 1 year and 2 years following your surgery; this is to let us know how well you’ve done in relation to regional and national averages, and to generate results to publish internationally.
We will normally see you in a follow up clinic at 2 weeks to check for early complications and then at frequent intervals with x-rays to check the shoulder continues to function well.
National Joint Registry (NJR)
The NJR records data about your reverse shoulder replacement to track the implant and see how well it performs, to enable us to continue to improve the level of care we provide. We also ask you to provide certain personal details (with your consent) to match your implant to you and follow it through in the long-term. To see more about how the NJR functions, click here.
For more information from the NJR about Shoulder Replacement click here.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery in Sheffield & Europe.
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