Shoulder arthroplasty, or total
shoulder replacement surgery, is less common than hip or knee replacement, but has been an established
treatment since the 1950s. Originally developed as a way to treat severe
shoulder fractures, total shoulder replacement surgery is now most often
used to treat conditions with chronic shoulder pain with goals of first
reducing pain, and secondarily increasing strength and range of motion
in the joint.
Through shoulder replacement surgery an orthopedic surgeon can address
several chronic pain conditions in the shoulder such as shoulder arthritis,
severe rotator cuff damage, and avascular necrosis, in which joint degradation
is caused by a lack of blood flow to the joint.
Rheumatoid arthritis is a condition caused by the body’s immune system
attacking the tissue between the bones of a joint, causing pain and swelling
with increased friction within the joint. Post-traumatic arthritis is
a chronic loss of cartilage and wearing down of a joint as a long-term
result of a previous injury.
The most common form of arthritis and most frequent condition resulting
in joint replacement is osteoarthritis, or degenerative joint disease.
Known as the wear-and-tear form of arthritis, it develops over the course
of years, with wearing down of the cartilage until there is increased
friction and bone-on-bone contact, which consequently causes more irritation
and inflammation in the joint.
Joint replacement surgery is generally recommended in more severe cases
of late-stage or end-stage arthritis after attempts have been made to
treat symptoms with other non-invasive approaches.
Appropriate shoulder replacement candidates often experience:
Severe pain interfering with daily activity
Persistent pain while at rest, regularly interrupting sleep
Lost range of motion and joint weakness
Lack of improvement despite other treatments
An orthopedic surgeon will often inspect the joint with imaging such as
an X-ray or MRI, looking for wear of cartilage, damage to the bone, and
specifically loss of space between the upper arm (humerus) and socket
(glenoid), where there should be space and soft tissue coverage allowing
for smooth movement.
Total Shoulder Replacement
A total shoulder replacement is really a bone and cartilage replacement
with an artificial surface. The shoulder itself is not replaced, as is
commonly thought, but rather an implant is inserted on the bone ends.
This is done with a metal alloy on the humerus and plastic spacer on the
glenoid. This creates a new, smooth cushion and a functioning joint that
can reduce or eliminate pain. Sometimes a reverse shoulder replacement
is indicated for various reasons, including torn rotator cuff.
Shoulder joint replacement procedures have an estimated success rate of over 90% with replacement
joints often lasting many years.
Results will vary depending on the quality of the surrounding tissue, the
severity of the arthritis at the time of surgery, the patient's activity
level, and the patient's adherence to the doctor's orders. Generally,
patients have significant relief from pain. Patients can also experience
improved range of motion and can often have an easier time doing normal
activities.
Reverse Shoulder Replacement
The explosion in the number of total shoulder replacement surgeries had
previously done little to help those with severe rotator cuff injuries,
but now the reverse total shoulder replacement has given those patients
an option to escape chronic shoulder pain.
In a traditional total shoulder replacement surgery, the ball-and-socket
joint of the shoulder is replaced with an artificial ball grafted onto
the top of the arm, and the socket component in the shoulder. However,
if you don’t have a good rotator cuff, which are the muscles that
stabilize the shoulder, and you have arthritis, then a regular shoulder
replacement would fail.
Reverse total shoulder replacement, approved by the FDA in 2003, offers
a solution. A hemisphere is installed on the shoulder blade, while a socket
joint is attached to the top of the arm bone.
Following a reverse total shoulder replacement, the joint is powered by
the deltoid muscle instead of the rotator cuff. There are a number of
special cases in which a reverse total shoulder replacement can provide relief:
Irreparable torn rotator cuff
Cuff tear disease, referred to as arthropathy
An unsuccessful previous replacement
Severe shoulder pain and difficulty lifting your arm away from your side
or over your head
Complex fracture of the shoulder joint
Chronic shoulder dislocation
Tumor of the shoulder joint
The reverse total shoulder replacement procedure has been shown to deliver
improved results for patients with severe rotator cuff damage, but initially
carried a higher rate of complications than the traditional replacement.
The most common complication, according to a 2010 study at the University
of Zurich, was scapular notching — an erosion of the scapular neck
due to impingement of the rim of the cup of the joint. That could also
be prevented, according to the study, by use of larger implant components
and shifting the positioning of the implant.
Hematoma, a swelling of a blood clot, the study noted, was a common issue,
but that it was one that could be better controlled.
Following years of advancement in techniques and technology, the risks
of the procedure have been reduced, as the long-term reliability of new
joints have improved for those suffering from some of the most extensive
cases of joint damage.
Shoulder Resurfacing
Shoulder resurfacing, also called resurfacing hemiarthroplasty, is a treatment
option in which the humerus, or arm bone, is mostly kept intact.
Shoulder resurfacing was introduced in the late 1950s, but has changed
over time, and some studies show positive results for the right patient.
Shoulder resurfacing involves removing the humerus from the socket of the
shoulder joint, resurfacing the ball of the joint with a metal cap, and
replacing the bone into the joint. It is a narrowly targeted procedure
typically for patients who are younger than other typical joint replacement
candidates, who still have a normal amount of cartilage covering their
joint socket, and who have a reasonably healthy rotator cuff.
Another factor is that it might be recommended for patients who may be
anticipating repeated surgery later in life.
Features of the procedure include minimal bone resection, meaning the least
amount of bone is removed, as opposed to total replacement, in which the
ball is taken from the end of the arm. In resurfacing, there is less chance
of the humeral canal, which carried nutrients through the arm, being affected,
and less chance of a peri-prosthetic fracture, in which a bone fracture
is caused by an attached implant.
Because there is minimal bone damage during the procedure, there are more
options for revision or replacement if there is a problem with the prosthesis.
Rehabilitation After Shoulder Replacement
After shoulder replacement surgery patients often go home one day later
with instructions to manage post-operation swelling and soreness.
The patient will often be wearing a sling most of the time for four to
six weeks after surgery. During this time the patient will also begin
a rehabilitation program involving regular appointments with a physical
therapist and a strength and flexibility routine for home.
What to Expect of Shoulder Replacement at Sauk Prairie Healthcare?
The Orthopedic surgeons at Sauk Prairie Healthcare specialize in joint
replacement procedures and can help guide you through appropriate options
to treat chronic shoulder pain.
If conservative treatments are proving ineffective and shoulder pain is
continuing to interfere with your quality of life, your doctor may refer
you to see a specialist at Sauk Prairie Healthcare. After diagnosis, joint
replacement specialists guide patients through initial education about
the process, preparation, the surgery itself, followed by the lengthier
process of recovery and follow-up.
Orthopedic Surgery, OrthopedicsView Profile
