Our Summary

This study looks at two methods of performing a specific type of shoulder surgery - reverse total shoulder arthroplasty (RTSA), which is a procedure that helps restore the function of the shoulder joint. One method involves keeping the existing ‘humeral stem’ (a part of the shoulder joint) in place, while the other method involves replacing it.

Researchers analysed different databases for studies comparing these two methods. They found seven relevant studies, which involved 236 shoulders in total, and evaluated the results.

The research showed that the method involving replacement of the humeral stem led to more complications, more time spent in surgery, more blood loss, and a higher chance of needing another operation. Therefore, the method where the humeral stem is kept in place seems to be the safer and more effective option for this type of shoulder surgery.

FAQs

  1. What is a reverse total shoulder arthroplasty (RTSA)?
  2. What are the two methods of performing a reverse total shoulder arthroplasty (RTSA)?
  3. According to the study, which method of performing a RTSA is considered safer and more effective?

Doctor’s Tip

A doctor might tell a patient about shoulder replacement:

“It is important to discuss with your surgeon the specific approach they will be taking for your shoulder replacement surgery. In some cases, keeping the existing humeral stem in place may have better outcomes and fewer complications compared to replacing it. Be sure to ask your surgeon about the risks and benefits of each method to make an informed decision about your treatment.”

Suitable For

Patients who are typically recommended for shoulder replacement, specifically reverse total shoulder arthroplasty, are those with severe shoulder arthritis, irreparable rotator cuff tears, complex fractures of the shoulder joint, or failed previous shoulder surgeries. These patients may experience significant pain, limited range of motion, weakness, and difficulty performing daily activities. Shoulder replacement surgery can help improve function, reduce pain, and restore mobility in these individuals.

Timeline

Before shoulder replacement:

  1. Patient experiences chronic shoulder pain, stiffness, and limited range of motion.
  2. Patient undergoes physical therapy, cortisone injections, and other conservative treatments to manage symptoms.
  3. After exhausting non-surgical options, patient and orthopedic surgeon decide on shoulder replacement surgery.

After shoulder replacement:

  1. Patient undergoes pre-operative assessments and tests to ensure readiness for surgery.
  2. Surgery is performed, either with replacement of the humeral stem or preservation of the existing stem.
  3. Patient undergoes post-operative rehabilitation, including physical therapy and exercises to regain strength and mobility.
  4. Patient may experience temporary pain, swelling, and limited range of motion in the shoulder.
  5. Over time, patient gradually regains function in the shoulder and experiences reduced pain and improved mobility.
  6. Follow-up appointments with the orthopedic surgeon monitor progress and address any concerns or complications that may arise.

What to Ask Your Doctor

Some questions a patient should ask their doctor about shoulder replacement include:

  1. What specific type of shoulder replacement surgery do you recommend for my condition?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery process and what can I expect in terms of pain and mobility during recovery?
  4. Will I need physical therapy after the surgery and for how long?
  5. What is the expected outcome of the surgery in terms of pain relief and improved function?
  6. Are there any restrictions or limitations I should be aware of after the surgery?
  7. How long do shoulder replacements typically last and are there any factors that could affect the longevity of the implant?
  8. What alternative treatments or therapies are available for my condition?
  9. How experienced are you in performing this type of surgery and what is your success rate?
  10. Are there any specific pre-operative or post-operative instructions I should follow to ensure the best possible outcome?

Reference

Authors: Kirsch JM, Khan M, Thornley P, Gichuru M, Freehill MT, Neviaser A, Moravek J, Miller BS, Bedi A. Journal: J Shoulder Elbow Surg. 2018 Apr;27(4):756-763. doi: 10.1016/j.jse.2017.08.020. Epub 2017 Oct 16. PMID: 29046255