Reverse Polarity Total Shoulder Replacement

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Aim:                       

To alleviate pain from shoulder arthritis with tendon/muscle dysfunction

To alleviate pain from irreparable tendon tears in absence of arthritis

To improve function in ‘pseudo paralysis’ due to massive shoulder tendon tears

 

Surgery type:         

Open surgery

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Anaesthetic:          

General (asleep) usually with a nerve block

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Objective:             

Open approach to the shoulder joint- deltopectoral approach

Subscapularis tendon released from the front of the shoulder

Shoulder capsule and soft tissues released to allow dislocation of the humeral head

Osteophytes (arthritic spurs) removed from the head

Ball cut to shape using a specialised jig and power saw

Access to socket with specialised retractors to visualise bone surface

Jig used to guide placement of a guide pin just below centre of the socket

Bone reamers and rasps used to shape the socket to receive metal base plate

Base plate inserted and fixed further using four screws

Metal hemisphere fixed into base plate with screws

Shaft of humerus (arm bone) opened with metal sound/sizers

When correct size obtained bone shaped to accept trial stem

Trial stem inserted into the humerus- care taken to get rotation of stem in bone

Plastic insert placed between sphere and stem to adjust soft tissue tension

Stem component is relocated/reduced back in to joint

When component size, rotation and tension acceptable the real prostheses can be constructed form modular parts

The real prostheses is inserted and reduced

The subscapularis is the reattached if tissue tension allows- ideal but not essential

Soft tissues are closed with stitches

A sling is applied to the arm                        

                               

Duration:               

90-150 minutes

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Scars:                     

1 (8-15 cm) - patient size dependent- oblique scar on front on the shoulder  

           

Sling:                      

Wear at night up to 3 weeks. Can remove as comfortable during day from 48 hours

External rotation as directed by operation note- depends on subscapularis repair

 

Sports:                   

3 months- non contact sports, cycling, jogging, breast stroke

6 months- contact sports

9 months- overhead sports

 

Work:                    

Sedentary jobs- return as pain allows 1-3 months

Manual jobs- may need to adjust activity for up to 4 months

 

Driving:                  

From 8 weeks dependent on pain and ROM