Reverse Shoulder Replacement Questions before initial consult

Perry01

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Hello, I am glad I found this forum, there is lots of good information here. I performed a search and found that some patients have had issues ranging from infection to lack of ROM and strength post RSA surgery and am getting a little anxious.

I am a 57-year-old retired firefighter and now work as a part-time ski patroller. I maintain an active lifestyle that includes paddle boarding, kayaking, canoe paddling and snow skiing. I have had two rotator cuff repairs to my right, dominant shoulder. The first repair lasted 10 years and the second only a year and a half.

My MRI shows full thickness tearing of the supraspinatus tendon that has retracted to the joint line and full thickness tearing of the infraspinatus tendon. Subscapularis tendon and biceps tendon showed only mild tendinitis. My humerus bone rides high that’s causing bone to bone interaction which leads to chronic pain. I also have limited strength.

My orthopedic surgeon informed me that there’s not enough connective tissue to do a traditional rotator cuff repair so he referred me to an associate who specializes in shoulder replacement and has, (according to his bio) performed thousands of shoulder replacements. He comes highly recommended and even performed shoulder surgery on my orthopedic surgeon. Anyway, my orthopedic surgeon told me that although I am a bit young for the procedure, I appear to be a good candidate for reverse shoulder replacement. It looks like I’m headed that way and my initial consult with the shoulder specialist in two weeks.

I’m sure many of my questions will be answered during my initial consult but I’m hoping to gain some insight from people who have actually had the surgery towards what to expect to ease my mind….

Generally speaking, will I have to stay overnight post surgery? How does recovery time compare to rotator cuff repair? Do the deltoid and pectorals major muscles become the main mover of the arm or are any existing (non torn) rotator cuff muscles used? What’s the longevity of the replacement joint, the rest of my life? How long will it take to fully recover? What kind of strength and ROM can I expect after full recovery? What kind of limitations can I expect after full recovery? Will I be able to maintain my active lifestyle?

Thanks in advance for your input,

Perry
 

benne68

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Hi @Perry01 and Welcome to BoneSmart!

While I don't personally have experience with TSRs, we have many members on this forum who do and who have had great results from their surgeries. I'm sure some of them will post to share their experiences with you.

In the meantime, let us know is you have a date for your surgery and which shoulder is being replaced so we can create a signature for you.
 
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Perry01

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I don’t have a date for the surgery yet. My initial consult with the shoulder replacement specialist is in two weeks. I assume I will communicate with his staff then to arrange for a date.

As for my signature, the RTSR is to be performed on my right shoulder. I have two previous RC repairs on the right side, the first in 2010 and the second in 2020.
 

Layla

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Hello Perry,
Welcome to BoneSmart. Thanks for joining us!
I‘ve created a signature reflecting your two rotator cuff repair surgeries. We will add your surgery date once you have it scheduled and share the information here. While I don’t know a lot about shoulder surgery either, you will receive feedback here. At least three staff members have experienced shoulder surgery, but they are not currently online. The weekends can be a tad bit slower, so please hang in there for the responses you’ll receive. Feel free to familiarize yourself with the site and the resources we have to offer. Let us know if you have any questions in regard to using the forum.
I wish you comfort and all the best as you await your upcoming appointment. :)
@Perry01
 
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Perry01

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Thanks Layla. I forgot to add that my wife is an RN and a wound care specialist. She will be using 6 weeks of sick leave to provide care while I am recovering.

I also failed to mention that I have had two rotator cuff surgeries on my left shoulder as well. 2012 and again in 2018. Although the pain is minimal I have greatly reduce strength and range of motion with the left shoulder. I suspect recovery from my right RSR to be a little more difficult
 
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Layla

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I hope your recovery won’t be too difficult for you. I’m guessing you’ll have great care from your wife as you’re healing. Such a blessing.
Thanks for the additional dates, I’ll add them to your signature.
I hope you have a nice week!
@Perry01
 

djklaugh

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@Perry01 Welcome to BoneSmart! I have had both shoulder joints replaced with very good out comes! However mine were both standard replacements not reverse ones. I do have a friend who had a reverse replacement and he said his surgeon gave him more "do not ever do this" restrictions than my surgeons gave me. I was told with my first one that I'd have a lift limit of 20lbs ... but when I saw the same surgeon 4 years later about the 2nd shoulder he said that restriction did not apply! So I can ( and have done) lift heavier weight but being an LOL (little old lady) I don't need to do that very often. The only things I have found that new shoulder joints do not allow are - can't do a crawl stroke when swimming ( might just be me) and (does not apply to you) hook a bra behind my back. I think the best person to ask your questions of is the surgeon who will do the replacement. Now a days implants are expected to last 30+ years!

As for length of hospital stay - in these days of COVID many hospital stays are pared down to either day surgery or just one night in hospital .... but IF you were having ANY medical issues after the surgery they would have you stay longer. With each of mine ( pre COVID) I stayed 2 nights then went home. Since shoulders are not weight bearing joints I found recuperation easier than doing the hips. When I had my right (dominant) shoulder done it was awkward not being able to do much of anything with that arm.

After the surgery my arm was in a bolster sling for about 4 weeks and PT did not start until about 6 weeks after surgery, except for some very gentle "swing the arm back and forth" exercises that were given in the hospital. Again ask your surgeon. IMO for best results - especially given your history of rotator cuff repairs - PT should be slow, gentle, and never include forcing the shoulder to the point of causing pain! It took me about 6 months with each shoulder to get to the point that surgeon and PT said I was "all healed up" AND I found that each shoulder continued to gain ROM and strength even after PT was finished.

Best of luck to you! And to let us know how you are doing!
 

Jamie

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Hi, @Perry01 and welcome to our community. Lucky you having an RN wife to give you an hand in recovery from your shoulder replacement. I think you will be pleasantly surprised to find recovery from either a regular or a reverse replacement is much less of a problem than your previous rotator cuff procedures. I had the regular replacement and, other than 6 weeks of not using my left arm at all, it was not bad at all. Pain levels were minimal and the worst part was really wishing I had a loving spouse to give me a hand with some of the things I wanted to do.

Some comments regarding your questions:

Will I have to stay overnight post surgery?
This will depend on our surgeon. I had my surgery on a Friday morning and came home on Sunday. I probably could have come home on Saturday, but asked to stay an extra day as I was by myself.

How does recovery time compare to rotator cuff repair?

Your surgeon will probably tell you that full recovery may take up to a year. But, you should be able to resume your life long before that. Usually you will have 6 weeks of immobility except for some simple movement exercises to keep your joint loose. Real therapy normally doesn't start until after you see your surgeon at 6 weeks. At this point, you'll be able to start doing some things with your arm, but you must take things very slow. You likely will have limits to what you can lift for maybe 6 months, possibly more as your surgeon will advise. It is critical that you adhere to the recovery schedule for activity that your surgeon establishes. In order to get the best result, you need to very gradually work back up to normal strength and mobility levels. This will not the be time to push yourself or try and hurry things up. Your body has to adapt to new muscles moving your arm and this takes time.

Do the deltoid and pectorals major muscles become the main mover of the arm or are any existing (non torn) rotator cuff muscles used?

In a reverse shoulder replacement, the deltoid muscle takes over for the rotator cuff muscles to move your arm. There have been some studies where it was attempted to do both the reverse replacement and rotator cuff repair, but the results were not good. This is something you should ask your surgeon about, but I would be surprised if he would be doing any repair of the rotator cuff muscles.

What’s the longevity of the replacement joint, the rest of my life?

This is pretty difficult to say right now. It's only been in the last 10 years or so that the implants and surgical techniques have improved to the level where they are now. So, there hasn't been enough time to know how long this type of joint replacement might last. However, in the past 5 years, the number of replacements has dramatically increased. Having the option to do a reverse replacement has made this life-changing surgery an option for people like you who are not candidates for a regular shoulder replacement. You should expect anywhere for 10 to 20 years out of your replacement....and possibly more. The things you will probably want to avoid as much as possible are activities that involve lifting above your shoulders.

How long will it take to fully recover?

As mentioned before, your surgeon will probably tell you a year for full recovery as a general rule. With my shoulder, I continued to improve both strength and range of motion for more like two years.

What kind of strength and ROM can I expect after full recovery?
There may be some limitations on your range of motion since the joint will be functioning a little differently than your original shoulder joint. But, both strength and ROM are things you can work on following surgery. Most people should be able to return to normal activities and not really think about their shoulder any more. This is great surgery that can allow you to continue to live the life you want. I have heard of some surgeons advising lifting limits for life, but mine did not. In the months following my shoulder replacement, I was able to pack up and load the car to go to the lake with no problems. I can reach up into cabinets to retrieve items above shoulder level. My only limitation is reaching upwards behind my back and I've heard the same for others. But I also know some people who have worked on this and it's improved. It's going to be an individual thing for you.

What kind of limitations can I expect after full recovery?

Talk to your surgeon about this, as he's the one who knows your specific case. But I wouldn't expect you'll have a lot of restrictions or limitations. You should be fine as you work up to increased activity gradually.

Will I be able to maintain my active lifestyle?

This is an individual thing, but I'm going to say you should be able to enjoy paddle boarding, kayaking, canoe paddling and snow skiing. I'm not sure what might be involved with ski patrolling, but would say that shouldn't be a problem as long as you aren't doing a lot of heavy lifting. You'll have to find the correct balance for you in terms of activity and lifestyle. The important thing is that your shoulder should function well with no more pain.
 

SaraK

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I have had rotator cuff repair or right/dominant shoulder and not a replacement. The reverse is used where there are rotator cuff issues.

As others have said, your surgeon will be the one to give you more answers but I'm under the impression that a replacement is an easier recovery/rehab than a rotator cuff repair. I've also heard that you will have more restrictions with a reverse than a standard but I don't know if that's a surgeon by surgeon issue.

Good luck and let us know how it goes.
 

tommyg

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I'm afraid I can't be of any help with your questions. I'm in almost the same boat. I came back here to do some research and saw your post and was happy to see someone like me. 57 and still wanting to be active.
I was all ready to have the have the RSR done in January . After consulting with my doctor he put me onto a procedure that just received FDA approval in July of 2021. It's implanting a balloon like device between the 2 bones at the shoulder. It was specifically made for unrepairable rotor cuff tears ,is done with some minor incisions so the recovery isn't nearly as bad as a replacement. Its called Stryker Orthospace if you want to google it. There is hardly any info on this site about it and since it was just approved in the US, very little info I could find. So I had the procedure done 1st week of January. It seemed to be healing well and there was some improvement. Then about the 3rd week of March it went downhill. The pain is back just as bad if not worse than before surgery. The implant is a bio-degradle balloon which is supposed to degrade and eventually pop. I guess mine popped. Just a heads up to do your research on this if your doctor offers it as an alternative. I see my doc in 2 days to see what he says. He was kind of scaring me with restrictions for the RSR so I jumped at the alternative. Kind of wishing I had just had the total replacement and I'd be well along recovering.
Good luck.
 
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Perry01

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Well I had my initial consultation today. My orthopedic surgeon gave me another option besides reverse total shoulder replacement to consider. The name of the procedure is called an arthroscope-assisted lower trapezius transfer. It uses a cadaver patch (achilles tendon) and is recommended for active patients age 55 and younger with inoperable massive rotator cuff tears. The good news is that this procedure provides great potential to regain a high level of strength and range of motion but the results are less predictable than a replacement.

My doctor used baseball as an analogy. He said he is done over 1000 shoulder replacements and that the results are quite predictable. He said to compare the results of the reverse shoulder replacement to hitting a double which equates to decent strength and range of motion but there will be limitations, especially lifting objects 15+ lbs. overhead.

He told me that with an arthroscope-assisted lower trapezius transfer, there is potential to hit in a triple or even a home run which equates to near normal range of motion and strength without much limitation. But since the procedure is relatively new, the results are less predictable. He has performed a handful of these procedures with promising results. He provided me with a link to a study of the procedure and its results which was performed at the Mayo Clinic.

My surgery is scheduled for May 18 so I have a few weeks to decide whether I’m going to go with the reverse shoulder replacement or the arthroscope-assisted lower trapezius transfer. I’d sure like to hit the ball out of the park my first plate appearance. The good news is that if it’s not successful he could always do the reverse shoulder replacement later. Any thoughts or advise is appreciated.

Has anyone heard of an arthroscope-assisted lower trapezius transfer? Below is a YouTube video and also a pdf of the case study performed at the Mayo Clinic.

edit: I need two more posts to be allowed to post a link. I will make a couple posts and include the links soon.
 
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Perry01

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I’m unable to post a link to the case study and video. I get this message:

“Sorry! You have reached your limit 0 links per post.”

It’s the arthroscopytechniques.org/article
 
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SaraK

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I was able to Google the article. Definitely seems like an interesting approach. There is definitely some upside if successful. As you say, the trade-off is possibly needing to go thru major surgery on that shoulder twice. The procedure is relatively new (the NIH article is saw was from 2016) so there is less data and less experience out there than with replacement. It also requires significant experience with an arthroscopic. I can't say which way you should go but I'd definitely be intrigued enough to do more research about it if I were you.
 
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Perry01

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I was able to Google the article. Definitely seems like an interesting approach. There is definitely some upside if successful. As you say, the trade-off is possibly needing to go thru major surgery on that shoulder twice. The procedure is relatively new (the NIH article is saw was from 2016) so there is less data and less experience out there than with replacement. It also requires significant experience with an arthroscopic. I can't say which way you should go but I'd definitely be intrigued enough to do more research about it if I were you.

Thanks Sara, if you do a search “arthroscope-assisted lower trapezius transfer” the article is from 2021 and it is the arthroscopytechniques.org/article.

I plan to do some serious reading and research before I decide which procedure to undergo
 

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