Reverse Total Shoulder Arthroplasty for fracture
What is Reverse Total Shoulder Arthroplasty for Fracture?
Reverse total shoulder arthroplasty is a type of shoulder replacement surgery in which the normal ball-and-socket structure of the shoulder joint is reversed. The glenoid (shoulder socket) is fitted with a prosthetic ball, while the humerus (upper arm bone) is fitted with a prosthetic socket. This reversal changes the mechanics of the joint, relying on the deltoid muscle rather than the damaged rotator cuff for shoulder movement.
Reverse total shoulder arthroplasty for fracture is a surgical procedure designed to address severe shoulder fractures, particularly those involving the proximal humerus, or cases with compromised rotator cuff function. It replaces the damaged shoulder joint with a prosthetic system that reverses the natural ball-and-socket arrangement, enabling the deltoid muscle to compensate for the lack of rotator cuff stability. The deltoid muscle forms the outer layer of the rotator cuff and is the largest and strongest muscle of the shoulder joint. The rotator cuff is a group of four tendons that join the head of the humerus to the deeper shoulder muscles to provide stability and mobility to the shoulder joint.
Indications for Reverse Total Shoulder Arthroplasty for Fracture
Reverse total shoulder arthroplasty for fracture is typically indicated for complex proximal humerus fractures that are difficult to reconstruct, especially in elderly patients with poor bone quality. It can also be used for individuals who have had poor results from other treatments, such as open reduction and internal fixation or hemiarthroplasty.
Preparation for Reverse Total Shoulder Arthroplasty for Fracture
In general, preparation for reverse total shoulder arthroplasty for fracture may include the following steps:
- A comprehensive medical evaluation, including a review of your medical history, physical examination, and laboratory studies such as blood testing to assess the patient’s suitability for the procedure.
- Imaging studies such as X-rays, CT scans, or MRIs are used to evaluate the fracture pattern, bone quality, and rotator cuff condition. A prosthetic system suitable for the patient’s anatomy and fracture type is selected.
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Providing your physician with a list of any medications or supplements you are taking
- You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting
- Stopping smoking, as it can negatively impact the healing process and increase the risk of complications
- Abstaining from food or drink for at least 8 hours prior to surgery
Procedure for Reverse Total Shoulder Arthroplasty for Fracture
In general, the procedure for reverse total shoulder arthroplasty for fracture may include the following steps:
- The patient is given general anesthesia or regional anesthesia with sedation.
- The patient is typically positioned in a beach chair position to provide optimal access to the shoulder.
- An incision is made over the affected shoulder to expose the shoulder joint.
- The fractured humeral head and any loose bone fragments are removed.
- Damaged cartilage on the glenoid (socket part of the shoulder joint) is prepared for implant placement.
- A baseplate is securely attached to the glenoid using screws or other fixation devices.
- A metal ball (glenosphere) is attached to this baseplate, effectively reversing the shoulder anatomy.
- The humerus (upper arm bone) is prepared by hollowing out the shaft to accommodate the humeral stem.
- A plastic cup (humeral socket) is fixed onto the humeral stem, creating a new socket for the reversed configuration.
- The components are assembled to ensure proper alignment and stability.
- If possible, remaining rotator cuff tendons or other stabilizing structures are repaired or reattached to the prosthesis to optimize joint function.
- The incision is closed with sutures or staples, and a sterile dressing is applied.
Post-Procedure Care and Recovery
After the procedure, the arm is immobilized in a sling for 4–6 weeks to allow initial healing, and movements are restricted during this period to prevent stress on the surgical site. Pain is managed with prescribed medications and, in some cases, regional nerve blocks. Wound care includes keeping the incision clean and dry, with follow-up visits for suture removal and monitoring for signs of infection. Physical therapy begins with passive range-of-motion exercises in the first 6 weeks to prevent stiffness, transitioning to active motion and strengthening exercises over the next several months. Full recovery typically takes 6–12 months, with regular follow-ups to ensure proper healing and prosthesis function. Patients are advised to avoid heavy lifting and high-impact activities to protect the shoulder long-term.
Risks and Complications
While reverse total shoulder arthroplasty for a fracture is generally effective, it carries certain risks and potential complications. These include:
- Infection
- Prosthetic loosening or failure
- Nerve or vascular injury
- Reduced range of motion compared to a healthy shoulder
- Hematoma (accumulation of blood around the joint)
- Blood clots or deep vein thrombosis (DVT)
- Chronic pain