what arm function can be expected if the scapula is removed due to cancer

The major difference between a standard shoulder replacement and a reverse procedure is that in a reverse shoulder replacement the brawl and socket parts of the shoulder joint switch sides. This means their natural position is reversed. Reverse total shoulder replacement is a complex procedure and is warranted by certain conditions. Call to request an appointment with one of our shoulder experts if you accept shoulder problems that may require shoulder replacement.

Why are these shoulder replacements called a "reverse" prosthesis?

Shoulder replacements are designed to remove portions of the bones of the shoulder joint that are arthritic (missing cartilage). The shoulder joint is a brawl and socket joint, with a ball (or humeral head) that is function of the humerus and a flat surface (which is chosen the socket) which is part of the shoulder blade (Figure 1). In a standard shoulder replacement, the ball portion of the shoulder (the humeral caput) is replaced by a metal ball and the socket is replaced by a plastic slice (Figure 2).

In the "reverse prosthesis" the shoulder articulation is still replaced with parts or components made out of metal and plastic (Figure 3). The big differences between a reverse prosthesis and a standard shoulder replacement is that in a reverse prosthesis, the ball is placed on the socket side of the joint. This is opposite where it is located in nature, or "contrary" of what you would look. The socket is then placed on the arm side where it is supported past a metal stalk in the arm bone (the humerus) (Figure iv). Thus the ball and socket are reversed from what occurs in nature.

How does it stay together?

Fortunately the reverse prosthesis can be put into identify with screws on the socket side which concord it into the bone of the shoulder bract (Figures 3 and iv). The ball and then screws into the plate which has been attached to the socket (Figure 3).

The part of the prosthesis placed into the arm bone is secured with cement which bonds the metallic to the os inside a few minutes (Effigy iv). The plastic socket slice then is press fit into the terminate of the stalk where it is deeply fixed by locking into the metal piece. This allows the socket to rotate on the ball so that the shoulder motion can be restored (Figure 5). The muscles around the shoulder likewise help keep the reverse prosthesis in identify.

Why should a person get a reverse prosthesis instead of a standard shoulder replacement?

A standard full shoulder replacement depends upon muscles and tendons around the shoulder joint to be intact. The muscles attach to the shoulder blade and turn into tendons which attach to the shoulder. These muscles and their tendons role to move the shoulder and are together called the rotator cuff. When these tendons become extensively torn so that they do not attach to the bone any longer, the shoulder oft does not function normally. The loss of the rotator gage can produce pain and besides loss of move. A normal shoulder replacement is designed to piece of work only if those tendons are intact. In dissimilarity, a reverse prosthesis is designed for situations where the rotator gage is torn or malfunctioning.

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What shoulder weather warrant reverse total shoulder replacement?

The main reason to consider a reverse prosthesis is when there is arthritis of the shoulder joint and the rotator cuff tendons are torn or gone. This is the nigh mutual surgical indication for a patient because a reverse prosthesis. In this situation this performance will give the patient pregnant pain relief and may also help with range of move of the shoulder. While range of move later on a opposite prosthesis may not exist completely normal, it is typically improved over the move previously lost due to the arthritis and pain.

Another reason to have a reverse prosthesis is if the rotator gage tendons are all torn and one cannot elevator the arm high enough to function. Typically in this case the shoulder is not painful but the inability to lift the arm is very disrupting to the ability to function in life. When the patient goes to lift the arm there is a prominence on the front of the shoulder, and this is called an anterior-superior migration or subluxation of the shoulder. In these cases pain may or may not exist a major factor for the reverse prosthesis, merely the principal reason for the replacement is to regain motion and office.

The tertiary about common reason to have a contrary prosthesis is if the shoulder has already had a replacement prior to the time a reverse prosthesis was available and the patient still has pain and loss of movement. Sometimes the regular shoulder replacement was placed for a fracture or for torn rotator cuff tendons and the shoulder continues to be painful. In this case, if a reverse prosthesis is needed, the surgery to place a opposite prosthesis is a footling more complicated. The reason for this is that the first, more traditional shoulder replacement has to be removed at the fourth dimension of surgery, and the reverse can then be placed in the shoulder.

Other reasons to have a reverse prosthesis are some fractures of the shoulder area, particularly ones that involve the proximal humerus (arm os) where the ball attaches to the shaft of the bone. In some instances, the bone is broken into many pieces or the ball may exist separate into parts.

The last reason to have a contrary prosthesis is because of a tumor in the proximal humerus that involves the bone of the shaft of the os or the ball of the humerus itself.

What is the surgery similar?

The surgery experience is very similar to that of a regular shoulder replacement with a few variations. The master factor in the recovery is whether this is the first shoulder replacement for the shoulder or whether an old prosthesis has to exist taken out during surgery. When this is washed, it is chosen a "revision" instance and the recovery may be different than when a showtime time (called a "primary") joint replacement is done.

The surgery is typically washed with a nervus block of the arm followed by a general coldhearted. The incision is in the forepart of the shoulder and the surgery takes almost 2 to three hours. Postoperative pain relief is obtained with pain medications orally and by vein if needed. Almost patients can begin moving the fingers, wrist and elbow the adjacent day.

Whether shoulder motion begins the solar day subsequently surgery depends upon how well the base plate and ball are fixed to the socket by the screws. In a contrary prosthesis at that place is some dependence upon the bone healing around the base of operations plate and screws. As a result, motility of the shoulder may be halted for a few days to a few weeks. Despite these precautions, near patients are allowed to use their extremity to eat, read or use a keyboard within a few days after surgery. The amount the patient can lift the arm depends upon many factors and each patient is different. The amount of movement allowed by the patient subsequently surgery also depends upon the fixation of the screws to the bone which tin exist adamant at the time of surgery. Lastly, the amount of move recovered after this surgery also depends upon how much motion the patient had prior to surgery.

Most patients donate a unit of measurement of claret prior to surgery which tin be given back to them if needed. For offset fourth dimension joint replacements blood is given back to the patient unremarkably only 10 to xx% of the fourth dimension. For revision cases where the surgery is longer, nearly 80% of cases demand a blood transfusion. Similarly, the length of time for surgery is longer for revision cases (three to 5 hours) and the recovery time for gaining function of the arm is longer. Other factors which influence the recovery fourth dimension include whether os grafting (adding bone where it is missing) is done, whether information technology holds well and how long information technology takes the bone to heal.

What results can I expect from reverse total shoulder replacement?

The reverse prosthesis is very proficient at providing hurting relief. Studies from Europe indicate that approximately 85-90% of patients who accept this procedure obtain excellent pain relief. The caste of pain relief depends largely upon the reason the process was done. The caste of pain relief for revision cases is a trivial lower than for procedures done for the first time, and this is believed to be due to the scar germination and long term impairment.

The opposite prosthesis also should restore some range of motion to the shoulder, but the degree of render is not as predictable equally pain relief. Nigh patients obtain the power to reach the top of their heads without the need to tilt their head. Most patients see improvement of motion in other directions, just if their rotator cuff is torn completely they may not see comeback in the power to accomplish out to the side away from the body (called "external rotation").

The long term survival rates (that is, how long it can stay in the shoulder before it starts to loosen and needs to have more than surgery) of the opposite prosthesis have been favorable. The reverse prosthesis has been used in France since the 1980s just was approved by the Food and Drug Administration (FDA) in the Us in April, 2004. As a effect, there are currently no long term studies of its apply in the United States. However, the experience of shoulder surgeons and patients from Europe seem to indicate that the prosthesis volition concluding 15 years nearly 90% of the time.

What are the potential complications of this procedure?

The complications of this procedure are similar to those of joint replacements of whatsoever joint in the body. There are complications similar to those of regular shoulder replacements and a couple unique to this prosthesis.

The most mutual complication is that the humerus or arm portion (the socket) tin can become dislodged from the brawl (the shoulder blade part) and the prosthesis is "dislocated." Basically the two parts of the prosthesis are not connected anymore. This complication is more common with the reverse prosthesis than with regular shoulder replacements. Fortunately it can exist managed normally by placing the arm back into the proper place and immobilizing the arm for a period of time. If the prosthesis continues to dislocate and so sometimes further surgery is needed to tighten things up.

The 2nd most common complication of concern after a reverse prosthesis is infection. This occurs rarely but if it does occur it can be frustrating for the patient and physician akin. Sometimes the infection can be controlled by surgery to wash out the joint and with antibiotics. If the infection becomes chronic despite treatment, then in that location are options for solving the infection, but they largely involve further surgery.

Another complication of this prosthesis is that the arm portion can make contact with the bone of the shoulder blade in certain positions. This contact tin create a groove in the bone of the shoulder blade that ordinarily is not painful. Commonly this complication does non require further surgery and can exist controlled with avoidance of the arm positions and with medication.

Other complications are very uncommon, but tin can rarely exist seen with this prosthesis or with regular shoulder replacements. These include tingling, numbness and weakness if the nerves to the arm stretched during surgery. Injury to blood vessels is very, very rare but tin can happen peculiarly when there is a lot of scaring and the patient has had multiple operations. Trouble with medical conditions, such equally blood clots in the legs (deep venous thrombosis) which can travel to the lungs (pulmonary embolus), heart attacks, strokes, drug or anesthetic reactions can occur with whatever performance, but in our experience these are very rare after shoulder replacement surgery.

Who should not have a opposite prosthesis?

There are just a few instances where a reverse prosthesis cannot be implanted. The kickoff is if the socket bone (of the shoulder bract or scapula) is likewise far gone to permit the component base plate to be able to be stock-still with screws to the bone. In some instances bone graft tin be added at the time of surgery which makes information technology possible to place the base plate and screws, or bone graft can be added to allow placement of the base plate at a after engagement.

Patients with an ongoing infection in the shoulder should not take a reverse prosthesis. Still, if the infection can be cleared upward then a prosthesis tin can be inserted. Whenever a shoulder replacement is attempted in a shoulder that has had a previous infection, the post-operative infection charge per unit is higher than if the shoulder never had an infection. This should exist discussed in item with your md prior to having this surgery done.

References

1. Frankle M, Siegal S, Pupello D, Saleem A, Mighell Grand, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-upward study of 60 patients. J Bone Joint Surg Am 2005;87(8):1697-705

2. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 1993;sixteen(1):65-viii.

3. Valenti P, Boutens D, Nerot Cea. Delta three reverse prosthesis for osteoarthritis with massive rotator cuff tear: long term results. In: Walch G, Boileau P, Mole D, editors. 2000 Shoulder Prosthesis. two to ten year follow-up. Montpellier: Sauramps Medical; 2001. p. 253-259.

4. Werner CM, Steinmann PA, Gilbart Grand, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator gage dysfunction with the Delta Iii contrary-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005;87(7):1476-86.

5. Boulahia A, Edwards TB, Walch G, Baratta RV. Early on results of a reverse blueprint prosthesis in the treatment of arthritis of the shoulder in elderly patients with a big rotator gage tear. Orthopedics 2002;25(two):129-33.

6. Rittmeister Grand, Kerschbaumer F. Grammont opposite total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator gage lesions. J Shoulder Elbow Surg 2001;10(1):17-22.

7. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D. Grammont inverted total shoulder arthroplasty in the handling of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre written report of lxxx shoulders. J Bone Joint Surg Br 2004;86(3):388-95.

8. Hatzidakis AM, Norris TR, Boileau P. Reverse shoulder arthroplasty; Indication, Technique and Results. Techniques in shoulder and elbow surgery 2005;6(3):135-154.

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Source: https://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/shoulder/treatments-procedures/reverse-prosthesis.html

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