Shoulder Joint Replacement Surgery is a safe and effective procedure to relieve pain and help you resume everyday activities. If non-surgical treatments like medications and activity changes are no longer helpful for relieving shoulder pain, you may want to consider shoulder joint replacement surgery.
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis.
Treatment Options are
- Partial Shoulder Replacement : replacement of just the head of the humerus bone (ball)
- Total Shoulder Replacement : replacement of both the ball and the socket (glenoid)
Possible Causes of Shoulder Pain & Disability
Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.
- Osteoarthritis (Degenerative Joint Disease) is an age-related “wear and tear” type of arthritis and usually occurs in people 50 years of age and older, but may occur in younger people, too.
- The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.
- Rheumatoid Arthritis is the most common form of a group of disorders termed “inflammatory arthritis” in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.
- Post-Traumatic Arthritis is followed by a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments may damage the articular cartilage over time that causes shoulder pain and limits shoulder function.
- Rotator Cuff Tear Arthropathy: In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage. A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy.
- Avascular Necrosis (Osteonecrosis) is a painful condition that occurs when the blood supply to the bone is disrupted. As the bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are few of its possible causes.
- Severe Fractures of the shoulder is another common reason people have shoulder replacements. When the head of the upper arm bone is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for severe shoulder fractures.
- Failed Previous Shoulder Replacement Surgery : Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation.
When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.
Your doctor may recommend shoulder replacement surgery, if :
- Severe shoulder pain interferes with your everyday activities such as reaching into a cabinet, dressing, toileting, and washing.
- Moderate to severe pain while resting. This pain may be severe enough to prevent a good night’s sleep
- Loss of motion and/or weakness in the shoulder.
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.
Pre Shoulder Transplant Orthopaedic Evaluation
Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether shoulder joint replacement is the best method to relieve your pain and improve your function.
- A medical history. Your orthopedic surgeon will gather information about your general health and ask you about the extent of your shoulder pain and your ability to function.
- A physical examination. This will assess shoulder motion, stability, and strength.
- X-rays. These images help to determine the extent of damage in your shoulder. They can show loss of the normal joint space between bones, flattening or irregularity in the shape of the bone, bone spurs, and loose pieces of cartilage or bone that may be floating inside the joint.
- Other tests. Occasionally blood tests, a magnetic resonance imaging (MRI) scan, or a bone scan may be needed to determine the condition of the bone and soft tissues of your shoulder.
Other treatment options — including medications, injections, physical therapy, or other types of surgery — will also be discussed and considered.
Types of Shoulder Replacement Surgeries
Your surgeon will evaluate your situation carefully before making any decisions. He or she will discuss with you which type of replacement would best meet your health needs. You may resolve your queries with your Orthopedist.
1. Total Shoulder Replacement
The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.
The prosthetic components come in various sizes. They may be either cemented or “press fitted” into the bone. If the bone is of good quality, your surgeon may choose to use a non-cemented (press-fit) humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid (socket) component is implanted with bone cement.
Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
2. Partial shoulder Replacement
(a) Stemmed Hemiarthroplasty
Depending on the condition of your shoulder, your surgeon may replace only the ball through the process of hemiarthroplasty. In a traditional hemiarthroplasty, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty.
Surgeons recommend hemiarthroplasty when:
- The humeral head is severely fractured but the socket is normal.
- Arthritis only involves the head of the humerus with a glenoid that has a healthy and intact cartilage surface
- Shoulders with severely weakened bone in the glenoid
- Shoulders with severely torn rotator cuff tendons and arthritis
Sometimes, surgeons make the decision between a total shoulder replacement and a hemiarthroplasty in the operating room at the time of the surgery. In comparison, patients with osteoarthritis get better pain relief from total shoulder arthroplasty than from hemiarthroplasty.
(b) Resurfacing Hemiarthroplasty
Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap like prosthesis without a stem. With its bone preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard stemmed shoulder replacement.
Surgeons recommend Resurfacing hemiarthroplasty when:
- The glenoid still has an intact cartilage surface
- No fresh fracture of the humeral neck or head
- Humeral bone needs to be saved
Due to its more conservative nature, resurfacing hemiarthroplasty may be easier to convert to total shoulder replacement, if necessary at a later time and is ideal for young patients.
3. Reverse Total Shoulder Replacement
In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.
Surgeons recommend Reverse Total Shoulder Replacement when:
- Completely torn rotator cuffs with severe arm weakness
- The effects of severe arthritis and rotator cuff tearing (cuff tear arthropathy)
- A previous shoulder replacement that failed
Shoulder Replacement Surgery Procedure
The procedure to replace your shoulder joint with an artificial device usually takes about 2 hours. After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to the hospital room.
Risks & Complications
Possible complications that are mostly successfully treatable could be:
Infection that could occur in the wound or deep around the prosthesis. And, it may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Apart from this, any other infection in your body can spread to your joint replacement.
Prosthesis Problems: Although prosthesis designs and materials, as well as surgical techniques, continue to advance, the prosthesis may wear down and the components may loosen. The components of a shoulder replacement may also dislocate. Excessive wear, loosening, or dislocation may require additional surgery (revision procedure).
Nerve Injury during surgery though highly infrequent & uncommon can’t be ruled out. Over time, these nerve injuries often improve and may completely recover.
Post Surgery Recovery
A careful, well-planned rehabilitation programme is critical to the success of a shoulder replacement.
You usually start gentle physical therapy soon after the operation. Your orthopedist or physical therapist will provide you with a home exercise programme to strengthen your shoulder and improve flexibility.
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