Reverse Shoulder Replacement

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Topic Title: Reverse Shoulder Replacement
Created On: 05/21/2005 09:35 AM

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 05/21/2005 09:35 AM

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anurse1

Posts: 4

Hi All. I had my reverse delta shoulder replacement in June last year and without a dout it has been a success. I was 51 yrs of age the youngest to be done by my surgeon( this is the UK )my other surgeon wont go down the road of the reverse replacement ( stuborn male doctor syndrome ) Following the operation I coud have had a PCA ( patient controlled analgesia ) this is usually morphine. but as a nurse myself Im not keen on the idea so I had a block which lasted 24 hours. Then the pain kicks in where by I needed regular analgesia and sorted out a regime of 2 to 3 hourly for the next 48 hours. Physio starts pretty quickly and in the case of the UK a lot is done by ones self at home. The harder you work at it and break the pain barriers the better as you recover quicker and with more movement. I could have gone back to work if i had an office job after 8 weeks but as I am a nurse I deceided to stay off as long as possible and as it was my hospital which was private annonced it was closing so I did not go back. The replacement is Titanium with a ball and socket fitment of some kind of polymide the same as the use for hip and knee replacements. ( by the way Titanium will make those metal scanners that you walk through at airports go off, if the airport has them set to high try Madrid what a pain they are.) If anyone wants to email me personally please do I will endevour to help ask even the most stupid of questions I dont mind. The operation has changed my life I am not doped up on analgesia, I can sleep without pain waking me up,I have a greater range of movement than I can ever remember and I think Im 36 again which is a bit confusing for the old man but thats his problem. All the best to all who are thinking of having it done or those who have had it done. Avril. Happy New Year.
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 05/21/2005 09:35 AM

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barbfromca

Posts: 6

Hi there, I have a few quick questions but I'll probably have more later. How many of these operations has your doctor done? What was his success rate? Here in the US, the operation was only approved in 2004 so there are no doctors who have done a lot of these operations. Mine has done four and that makes me nervous. He does have a number of them scheduled for this month, though. Apparently, there are a lot of people waiting for some solution to their problems. Also, you say you were off of work for 8 weeks. Wow! I was hoping to be off of work for about 2 weeks. I am a manager of a small real estate office and it just started the job last year, so it would be quite difficult to be off for that long. If you could describe those 8 weeks, I would have a much better idea of whether I could have been at work for that time. Also, how long until you could drive? When I had my first rotator cuff repair, I didn't drive for 2 1/2 weeks. Thanks so much for writing. It sure helps to be able to talk to someone who has had the operation. Barbara
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 05/21/2005 09:35 AM

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Cheryl17

Posts: 5

Hi Barbara, It does sound like Dr. Norris is the most knowledgable man in your area - for the reverse total shoulder. I would love you to send some of the links you have to more info about the process and the products used. I am 64, very active, small -120lbs and don't have enough bone in my scapula to support the glenoid component of the Delta reverse prosthesis unless i have more bone grafted onto my scapula. Both Dr. Bigliani in NY City and Dr. Loren here didn't think much of that. Dr. Loren said it would change the entire mechanics of my upper left side. Their big objection is the heavy metal ball with its 4 large screws which must be secured into the scapula. It certainly would be good for you to consult with Dr. Norris, and do ask him about any products in the pipeline which might be improvements. I am leaving for the UK next week and plan to have a consult with a shoulder specialist there - I'll let you know what transpires. Best Regards, Cheryl
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 05/21/2005 09:35 AM

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PatFBoneDoc

Posts: 3

Dear Barbara, I am an Orhtopaedic surgeon specializing in shoulder surgery. I would like to offer my insight into the Reverse Shoulder replacement. I have performed the procedure eight times since it was approved and so far I am extremely pleased with the results. Every patient has done well in the early postoperative stages and are very happy that they had the procedure. I want to warn you however that this procedure was designed for patients with severe pain and disability. The recommendation for the procedure was for patients over 70, but this is not very realistic in this country. We said similar things about knee and hip replacements not to long ago but now do them in just about any age patient who needs it. It hard to tell someone suffering with horrible pain to wait 20 years to have a surgery that could take away their pain completely. The reverse shoulder is for patients that are severely disabled and are at the end of their rope. I tell my patients that this is a salvage procedure to relieve pain and restore function but it is not something that you are glad to have done. There really is no further procedue to do if it fails. In France, they have been doing this procedure for over twelve years and have good long term results in patients with primary rotator cuff arthopathy. If I can answer any questions for you feel free to contact me.
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 05/21/2005 09:35 AM

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barbfromca

Posts: 6

Hello, Thank you very much for writing to me. I do appreciate your candor in telling me what the expectations are for this procedure. It is encouraging to hear that your patients are doing well. I do wonder, howevever, after reading your post, about whether this procedure is really for me. I am not having severe pain and am not severely disabled. However, I have 3 of the 4 tendons torn totally in my rotator cuff (only the teres minor is intact) and the biceps tendon is out of place. I am not able to lift my right arm (dominant arm) above my waist and can get it to chest height with a bit of pain. I also cannot raise it on the side of my body. My understanding is that there is nothing else that can be done for me other than this operation. It cannot be repaired. My dilemma is that I am 58 years old and want to have a long life and be able to use my right arm fully. Are you saying that I should wait until I am experiencing a great deal of pain to have this operation? I realize that it is quite complex and that there is nothing further to do after this one and that really scares me. I do intend to cancel the surgery date I have scheduled for February 7th because I am not at all convinced that this is the right thing to do. Any comments would be appreciated. Barbara
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 05/21/2005 09:35 AM

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anurse1

Posts: 4

Barbara please take into consideration that this is operation is not done just for the pain. I am the youngest person my consultant has performed this operation on. I like you spent months arguing with myself about this type of operation but when it came to the push what choice did I have.I was having difficulty raising my arm to feed myself, becoming more frustrated at not being able to do things, which in turn triggers off a chain of frustrations. The other patients who have had this done range from 55 upwards and all have had amazing results discussing it with my physio she told me that the range of movement and the expectation of the patient and the consultant were far graeter than either had hoped for. Your 58 go for it with courage and a determination as I did. Your other choice is to be a cripple and you certainly dont sound like the type of woman to put up with that. Hope you go with the decision to start a new life and get that arm fixed. BFN Avril x
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 05/21/2005 09:35 AM

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kryckert1

Posts: 182

Hi Guys, I wanted to put my 2-cents in this discussion. I have been on this website for over 5 years. I am now 34 years old, and have had 31 surgeries on my left shoulder and 4 on my right. I have had 2 failed TSR's, the first because of a staph infection, the second because we finally figured out that I have a genetic disorder and my body does not like titanium. I finally saw Dr. Hawkins in Vail, CO and he had 3 recommendations for me. The first was to try a new procedure called a Shoulder Girdle. The second was a reverse shoulder replacement and the third was a fusion. I chose the shoulder girdle, and I am a year out from surgery and have never been happier. Yes, I still have some pain every now and then and I have about 65% use of my arm for lifting or doing overhead stuff. Dr. Hawkins had a lot of information on the reverse replacement and I did a lot of research on it. What I found was that a reverse was usually used in cases where the patient didn’t have enough bone on the humeral side to put a normal replacement in. Also, it was used primarily for patients that were in tremendous pain. The reason why I say that is because if the reverse doesn’t work, usually the next step would be a fusion. I urge you to try everything you can possibly try, before attempting to let them cut your humeral head and socket out. Once you have this type of surgery, there is no turning back and putting things back. Make sure you really understand what the procedure is about, and I will say it again, they actually cut your bone out. You said you were not in tremendous pain, but also do not have much use of your arm. I would really look into the replacement as an option, but I would really do some more research and make sure you know exactly what you are getting into. Make sure you ask questions, lots of them. If you are uncomfortable with what you are being told by one doctor, go get a second opinion. See if there is any type of therapy, like a pool, that you can try to get some strength back in your arm. I would try everything, before I let them cut on me. I am now dealing with the issues in my right arm, and trust me, I understand what you are going thru and how confusing it is. Good Luck! Kirsten


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Kirsten
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 05/21/2005 09:35 AM

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PatFBoneDoc

Posts: 3

Dear Barbara, The purpose of this surgery is to both relieve pain and restore the ability to raise your arm. If you have little to no pain then you have to decide id whether restoring the function of your shoulder is worth the risk. I have a close personal friend who had a severe shoulder injury and eventually had a partial shoulder replacement(not the Reverse). He can't raise his arm but he has no pain and has decided to live with this disablity and use his opposite arm for overhead activities. That is his decision to make and you have to decide what is most important for you. The youngest patient I have performed the procedure on is 53 years old. She had a shoulder that was dislocated for two years and had a fracture that was healed in the wrong position. She understood the risks and decided to procced with the surgery. She had the same injury on her opposite shoulder and I performed a standard Total shouler replacement so I am interested to see which performs better. I have performed many standard total replacemenmts in patients in their 50's with severe arthritis so I don't think your age is big factor. The main issues for you are your current quality of life and your expectations for your shoulder. Good Luck!
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 05/21/2005 09:35 AM

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barbfromca

Posts: 6

Hello, Thanks to everyone who has been giving me their opinions on the reverse shoulder replacement. I am a bit confused now as to whether there are other options other than the reverse shoulder replacement for someone like me with a massive rotator cuff tear (3 of 4 tendons totally torn, with only the teres minor in place) plus the biceps tendon out of place. Is a regular shoulder replacement an option? My doctor indicated that it was not because of the almost totally torn rotator cuff. Also, has anyone had the deltoid flap operation? My original doctor who did the first rotator cuff repair that either retore or did not take referred me to another doctor and they were going to operate together and do the deltoid flap operation. When I found out that the doctor who would be performing the operation had not done very many of them and also that 50% of them tear afterwards, I opted not to have that operation and to instead have another doctor try to repair the rotator cuff through arthroscopy. Anyway, I have been told that this reverse shoulder replacement is the only way to go. Is that true? Also, it must make a difference which company makes the component parts that are used. How do I know which is better? Barbara
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 05/21/2005 09:35 AM

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PatFBoneDoc

Posts: 3

Dear Barbara, I think that the deltoid flap is a terrible choice and would advise strongly against it. I don't know anyone who does that procedure anymore especially with the great results we are getting from the reverse shoulder. Also, the reverse shoulder requires a functioning deltoid to move the arm and if you have the deltoid flap you will probably not be able to have the reverse later. From my experience I would say go for the reverse shoulder now or do nothing else until you are ready.
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 05/21/2005 09:35 AM

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sl2223

Posts: 1

Barbara: I just ran across this forum. I wish I had known of it about 3 months ago. Only because it would have been so wonderful to talk with others re the reverse delta shoulder prosthesis. I underwent the reverse prosthesis Jan. 20,'05. I am a 56 year old woman with numerous medical problems. Including adult-onset rickets, which softens my bones - making this decision more challenging for me and I am sure my surgeon. My shoulders (both) were disabling from rotator cuff (complete) tears and osteoarthritis. I was in so much pain, and almost helpless - without use of my shoulders. The surgery wasn't bad. I did and still have some type of nerve involvement from the surgery. My fingers feel as though they are asleep, but Barbara, I have full overhead movement - absolutely pain free. I was only in a sling for a week. Began exercises the first post=op day with a physical therapist. I thought it would be much worse. My right shoulder had previously undergone rotator cuff repair, and it needs a reverse prosthesis also. Due to my "soft bones", and prior rotator cuff repair, I am blessed the Cat Scan indicates I have enough bone to have the delta reverse prosthesis procedure performed on it. I must admit, I am now frightened as my surgeon did not tell me if this prosthesis failed, there was nothing else that could be done. Now I am wondering, what will happen if the prosthesis becomes infected or loosens? Do you or anyone know or care to share the bad news with me should that happen? I certainly do not regret the first procedure. I, now realize, after reading this forum, I was just one of many who is contemplating the delta reverse prosthesis. I told my family, one week after surgery, I was ready to have my other shoulder replaced. It felt so wonderful to have the pain gone, and now to have full overhead range of motion. I will always have rotation disability because there was no rotator cuff to salvage. Not one muscle. But I am so much more independent. My sleep has increased from 2 hours to nearly 6 hours. My other osteo (spine) and right shoulder wakens me at 6 hours. Please let me know if I can help you with any other info. I have never participated in a discussion forum like this. This is absolutely wonderful to connect with others. Sandra
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 05/21/2005 09:35 AM

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kryckert1

Posts: 182

Hi Sandra, I have had 2 failed total shoulders, just regular, not reverse. The first one I developed a staph infection and the socket came loose so I had to have them removed. The second my shoulder was frozen for almost 2 years, and I was in so much pain I couldn't function. I finally got in to see an expert in Vail, Colorado. He gave me 3 options to try. He said he wanted to try a shoulder girdle, he removed all of the hardware and used synthetic tissue to fill in all of the empty space. The second would have been a reverse-replacement and if that failed, he said the only other option was a fusion. I went with the first option and am a year and seven months post op and doing great. I am not sure if fusion would be the next step for you if your reverse were to fail, as each person and case is different. I do know that is what Dr. Hawkins told me. Hope your replacement works and you have 100% recovery. Kirsten


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Kirsten
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