Reverse Total Shoulder Arthroplasty
Reverse or Inverse Total Shoulder Arthroplasty (rTSA) initially designed and used in Europe in the late 1980s by Paul Grammont in France (center in photo, I am on the right). I spent time training in France before it received FDA approval for use in the United States in March of 2004.
rTSA has several advantages over anatomical TSA (aTSA). It does not need a functional rotator cuff to have a good result. It also can have true bone ingrowth from the scapula to the implant. It can recover faster than aTSA. It can be easier to revise if both components have good ingrowth. Disadvantages include potentially a higher complication rate and decreased internal rotation.
General Information
You should wear a sling when sleeping or in a crowded situation
You do not need a sling during the day if the arm is at the side
You may shower immediately, but do not submerge the dressing.
Do not take off the steri-strips
It takes 3 months for the soft tissues to heal
Avoid Dislocation
Avoid shoulder extension past neutral. No combination of shoulder adduction and internal rotation should be avoided for 12 weeks postoperatively.
tucking in a shirt or performing bathroom /personal hygiene with the operative arm may be dangerous activity particularly in the first 3 months.
Phase 1:
0-6 weeks
Phase 1 basically allows the skin to heal, to restore motion and avoid stiffness, and protect the repair of any tendons, and allow the body to grow into the metal of the prosthesis for a durable body-prosthetic interface
Phase 1:
- control pain and swelling. take ice and pain medication as prescribed as needed. drink water and take over the counter stool softeners like colace.
- allow skin to heal (2 weeks). DO NOT remove steri strips. They can fall off naturally. If they start to curl up, you may cut it with a scissor.
- The wound should be water tight for a shower as there is skin glue and steri-strips protecting the incision. To wash under the affected arm, bend over at the waist and let the arm passively come away from the body. It is safe to wash under the arm in this position. Do not scrub or get excessive water over the surgical site.
- You should wear a sling while sleeping or for comfort or while out. You do not need a sling when awake and walking and sitting in a controlled environment.
- begin pendulum motion of the arm
Phase 1:
You should be stretching every day, 5 times per day
Should include pendulum exercises, passive external rotation, passive arm elevation, scapular retraction, shoulder shrugs, and movement of the elbow and hand
Usually, formal physical therapy is not required
Phase 2:
6-12 weeks
Continue to try to get maximum forward elevation passively
continue to try to get maximum external rotation at the side
Work on Active motion
Avoid hyperextension
no lifting more than one pound
After 12 weeks
Enjoy your shoulder
If you develop pain, please return as soon as possible
tell a dentist that you have a shoulder replacement
NEVER fall!