The reverse shoulder arthroplasty (CPT Code 23472) is a surgical procedure normally conducted for relieving pain caused by arthritis as well as massive rotator cuff tears. Also known as the reverse shoulder replacement, this operation has the ball of your shoulder joint where the socket should be and vice versa, which is the "reverse" of your normal anatomy. While this may sound strange, the arrangement works well for those who’ve lost their regular shoulder mechanics because of arthritis or massive rotator cuts.
How this works is that the procedure makes the larger shoulder muscle or the deltoid muscle more efficient. In case you have rotator cuff tear arthropathy, the deltoid helps make up for the deficiency. The reversal of the ball and socket makes the large shoulder muscle more able in lifting the arm overhead. It also compensates for a torn rotator cuff.
The main reason for developing the reverse shoulder arthroplasty was that conventional surgical options for shoulder arthritis did not yield the desired results on patients with rotator cuff tear. Total shoulder replacements do not work in such cases either.
You doctor may advise you to go through the reverse shoulder arthroplasty, in case you are suffering from arthritis, rotator cuff tears and rotator cuff tear arthropathy.
The most important thing to do before a surgery of this kind is to get as much information on it as possible. Set up an appointment with your doctor, so that you can get all your queries clarified beforehand.
During your visit, inform your doctor about all the medication you take on a regular basis. You may need to discontinue some of them for a while, depending upon what your doctor says.
On the day of the surgery, it is best to get admitted into the hospital in the earlier part of the morning. Avoid eating and drinking anything for at least 8 to 12 hours before the surgery is scheduled to take place.
Finally, be prepared to stay at the hospital for a couple of nights.
The surgical procedure used for the reverse shoulder replacement is quite similar to the regular shoulder replacement surgery, but the main difference is in the insertion of the artificial parts.
You will probably need general anesthesia, so that you sleep through the surgery without feeling a thing. Once the anesthesia takes its effect, the surgeon will make an incision through the large arm muscle. After cutting through the skin, the nerves, blood vessels and muscles are isolated and moved to one side. Your surgeon will then cut into the joint capsule to enter the shoulder joint.
After that, the ball part of the humeral head will be removed using a bone saw. The inner hollow of the humerus is prepared with the help of a rasp, which allows the doctor to mold the space and place the stem of the humeral component within the bone. The glenoid is then replaced with a metal ball.
After anchoring the joint, your surgeon will check if the fit is proper, before stitching up the joint capsule. The muscles will be returned to their original positions and the skin will be stitched back.
Finally, your surgeon will cover the incision with a bandage and place your arm in a sling. The entire procedure takes about 2 to 3 hours.
In all probability you will need to spend two days at the hospital while your recovery process begins. A therapist will get you started with the exercises you need to practice regularly before you leave the hospital. The total recovery time is about 3 months, during which you need to undergo physical therapy.
Do bear in mind that the anatomy of your shoulder has been reversed during the procedure, which needs to be preserved. Wear the sling as advised by the doctor, to avoid straining your shoulder unnecessarily. Do not lift any heavy weights or perform any strenuous exercises, which could cause dislocation or other similar problems.
Complications can occur with just about any medical surgery, including a reverse shoulder arthroplasty. Some of the possible complications include -
Some of these complications are more serious than the others and need to be addressed by a doctor immediately. Therefore, it is important that you schedule regular doctor visits after the surgery and discuss everything you fell during these sessions.
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