The Delta (reverse) Shoulder Prosthesis.

Introduction.

Arthritis of the shoulder with a large or irreparable Rotator cuff tear is a condition which can be painful and  seriously compromise the function of the shoulder. In the past this condition has been very difficult to manage effectively. Arthritis of the shoulder is usually treated with a standard shoulder joint replacement but without a functioning rotator cuff a regular shoulder replacement will not be successful. In order to address this problem shoulder surgeons have developed a specially designed reversed prosthesis ( the Delta Shoulder Prosthesis) that can be used in these situations. This reversed prosthesis works by reversing the usual positions of the ball and socket in the joint replacement.

In the normal shoulder, the rotator cuff muscles hold the ball of the arm bone (humerus head) in the socket of the shoulder. They counteract the upward pull of the deltoid muscle. This is not possible when the rotator cuff is torn and the arm bone rides upwards.

The Reversed (Delta) shoulder prosthesis provides a fulcrum against which the deltoid muscle can work to elevate the arm.

When the rotator cuff is intact or repairable, shoulder arthritis is often best treated by total shoulder replacement.

Incidence.

Rotator cuff tear arthropathy (or shoulder arthritis with a large rotator cuff tear) most commonly occurs in individuals over the age of 65 and is more common in women than men.

Diagnosis.

Rotator cuff tear arthropathy results in a progressive loss of shoulder function, with pain, weakness and loss of motion. Examination of the shoulder demonstrates weakness and a grinding sensation on movement and a typical appearance on X-ray. On x-ray the humeral head can be seen rubbing the undersurface of the acromion

Treatment

Medications

Mild painkillers such as Panadol may relieve some of the symptoms of cuff tear arthropathy. In other patients stronger painkillers may be required.

Exercises

If the symptoms of rotator cuff tear arthropathy are mild, the condition may be assisted by gentle exercises and physiotherapy. Heat packs also help with the control of symptoms.

Surgery.

When pain becomes more severe, surgery may be indicated. This allows arthritic shoulders to regain some of their lost function and diminish the pain.

Joint replacement surgery can improve the mechanics and function of the shoulder, but cannot make the joint as good as it was before the onset of the arthritis. The outcome of the procedure depends on the health and motivation of the patient, the condition of the shoulder, and the surgery. The greatest improvements are in the ability of the patient to sleep and to perform activities of daily living. Because the tendons of the rotator cuff are not repairable in this situation , normal strength and function of the shoulder cannot be regained.

Risks

Fortunately complications are unusual, but like all other surgical procedures, may be associated with this procedure. The risks of this surgery include, but are not limited to the following: infection (which can be sufficiently serious to require revision surgery, including removal of the prosthesis), injury to nerves and blood vessels, fracture, stiffness or instability of the joint, dislocation, loosening of the prosthesis, pain, failure of tendon or muscle attachment, and the need for additional surgeries — any or all of which may result in major loss of function to the arm. There are also risks involved in anaesthesia and blood transfusion (although transfusions are not usually necessary).

We take elaborate measures and use special techniques to minimize these risks, but cannot totally eliminate them.

Preparation

Delta Shoulder joint replacement is considered for healthy and motivated individuals in whom cuff tear arthropathy is complicated by instability and /or arthritis interfering with function of the shoulder and causing pain.

Patients should endeavour to be in the best possible condition for this procedure. Smoking should be stopped before surgery and not resumed for at least three months afterwards. Any heart, lung, kidney, bladder, tooth, or gum problems should be treated before surgery. Any infection may be a reason to delay the operation. Some medications (such as aspirin, anti-inflammatory medications and warfrin) may need to be modified or stopped.

The arm needs to be protected for three to six weeks after the procedure. Driving, shopping and performing usual work or chores may be difficult after surgery. Plans for necessary assistance need to be made before surgery. For individuals who live alone or those without readily available help, arrangements for home help should be made well in advance.

Recovery and rehabilitation.

Early protected motion after shoulder replacement achieves the best possible shoulder function. Rehabilitation is begun immediately after surgery. An overhead pulley is used to assist motion.

It is important that the reconstructed shoulder not be stressed too much until it has had a chance to heal. You may no lift nothing heavier than a cup of coffee for the first few weeks after the surgery.

Rehabilitation is best performed by the individual themselves at home. Occasional visits to a physiotherapist may be necessary.

In general, patients are able to perform gentle activities of daily living with the operated arm at the side starting four weeks after surgery. Driving should be delayed until the patient can handle their vehicle safely, comfortably and confidently. This may take up to six weeks depending on the type of vehicle.

For postoperative rehabilitation regime following Shoulder Replacement click here: Post-op TSR

For a list of possible complications following Shoulder Replacement please go to: Complications TSR

Home | About Your Condition

The information on these pages is presented as a rough guide to help you understand your condition better. The information is in no way intended to be a comprehensive coverage of the subject. As all patients and their conditions are different, the treatment may vary from time to time. All patients are encouraged to take steps to ensure that they are as well educated about their conditions as possible. Other sources of information inc

Philip Allen Orthopaedic
P PO Box 1089, Coolangatta, QLD, 4225, Australia
T +61 7 55980977  F +61 7 55980016 E allen@bonedoctor.com.au
www.bonedoctor.com.au