Shoulder Replacement

Shoulder Replacement

Shoulder replacement surgery is effective in relieving shoulder pain and allowing patients to continue their daily activities.

Shoulder replacement surgery was first performed in the 1950s in the United States to treat severe shoulder fractures. Over the years, shoulder joint replacement has also been used for many other painful conditions of the shoulder, such as different types of arthritis.

According to a May 2021 article published in the Journal of Shoulder and Elbow Surgery (JSES), more than 100,000 people currently undergo shoulder replacement surgery each year in the United States. This includes total shoulder replacement, hemiarthroplasty, and reverse shoulder replacement. If nonsurgical treatments such as medications and activity modifications no longer work to relieve your shoulder pain, you may want to consider shoulder joint replacement surgery.

What are the reasons for shoulder replacement surgery?

Here are some conditions that may require a shoulder replacement surgery:

Osteoarthritis (Degenerative Joint Disease): This is a type of arthritis that occurs due to age-related wear and tear. It usually occurs in people aged 50 and over, but it can also be seen in younger people. In this condition, the cartilage that cushions the shoulder bones wears away. The bones then rub against each other. Over time, the shoulder joint gradually becomes stiff and painful. Unfortunately, there is no way to prevent osteoarthritis from developing, and it is a common reason for shoulder replacement surgery.

Rheumatoid Arthritis: This is the most common form of a group of conditions called inflammatory arthritis, and is a disease in which the synovial membrane surrounding the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage, eventually causing cartilage loss, pain, and stiffness.

Post-Traumatic Arthritis:It can occur after a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments can damage the joint cartilage over time. This can occur after a broken bone, a dislocation, or both.

Like other types of arthritis, post-traumatic arthritis causes shoulder pain and limits shoulder function.

Rotator Cuff Tear Arthropathy: A patient with a very large, long-standing rotator cuff tear may develop a condition called cuff tear arthropathy. In this case, changes in the shoulder joint caused by the rotator cuff tear can lead to arthritis and destruction of the joint cartilage.

Avascular Necrosis (Osteonecrosis): Avascular necrosis (AVN), or osteonecrosis, is a painful condition that occurs when the blood supply to the bone is compromised. Osteonecrosis can lead to destruction of the shoulder joint and arthritis because bone cells die without a blood supply.

Risk factors for avascular necrosis include:

  • Chronic steroid use
  • Complications from deep-sea diving
  • Excessive alcohol use
  • Severe fracture in the shoulder
  • Sickle cell disease

Severe Fractures: Severe fractures of the shoulder bone are another common reason for shoulder replacement surgery. When the head (ball) of the upper arm bone is broken, it can be very difficult for the surgeon to replace the bone fragments. Additionally, blood flow to the bone fragments may be interrupted. In this case, a shoulder replacement may be recommended.

Elderly patients with osteoporosis are at the greatest risk for severe shoulder fractures. In fact, even a fall from a standing height can cause a severe shoulder fracture in an elderly person whose bones are weakened by osteoporosis.

Previous shoulder replacement surgery failure: Although rare, some shoulder replacements fail due to the following factors:

  • Prosthesis loosening
  • Prosthesis parts wearing out
  • Infection
  • Dislocation

When these situations occur, a second replacement surgery, called a revision surgery, may be necessary.

Is shoulder replacement right for you?

The decision to have shoulder replacement surgery should be a collaborative effort between you, your family, and your orthopedic surgeon. There are several reasons why your doctor may recommend shoulder replacement surgery. Surgery may be a good option for those who have:

  • Severe shoulder pain that interferes with/makes it difficult to perform daily activities (such as reaching into a closet, getting dressed, going to the bathroom, and washing your face, etc.)
  • Moderate to severe pain at rest. This pain may be severe enough to interfere with sleep.
  • Loss of movement and/or weakness in the shoulder
  • Failure to achieve significant improvement with other treatments, such as anti-inflammatory medications, cortisone injections, and/or physical therapy.

How is your eligibility for shoulder replacement evaluated?

A comprehensive evaluation is performed to determine if you may benefit from this surgery. The evaluations typically include:

Medical history: Your orthopedic doctor will gather information about your general health and ask questions about the degree of your shoulder pain and your ability to function.

Physical exam: Your doctor will evaluate the movement, stability, and strength of your shoulder during the exam.

X-rays: X-rays help determine the extent of damage to your shoulder. They may show loss of the normal joint space between bones, flattening or irregularity of the shape of the bone, bone spurs, and loose pieces of cartilage or bone floating in the joint.

Other tests: Sometimes your doctor may order blood tests, a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan to determine the condition of the bones and soft tissues of your shoulder.

Based on their evaluation, your doctor will decide whether shoulder replacement is the best option to relieve your pain and improve your function.

What are the types of prosthesis surgery?

In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial parts called prostheses. Shoulder replacement surgery options include:

  • Replacing only the head (ball) of the humerus bone (Hemiarthroplasty)
  • Resurfacing (Hemiarthroplasty)
  • Replacing both the ball and the socket (glenoid) (Total Shoulder Replacement)
  • Reverse Total Shoulder Replacement

What is hemiarthroplasty like?

Depending on the condition of your shoulder, your surgeon may replace only the ball. This procedure is called hemiarthroplasty. In traditional hemiarthroplasty, the surgeon replaces the humeral head (ball) with a metal ball similar to the component used in total shoulder replacement.

Some surgeons recommend hemiarthroplasty when the humeral head is severely fractured but the socket is normal. Hemiarthroplasty may also be the best option for patients who:

  • Have arthritis when there is a glenoid that contains only the humeral head and has a healthy, intact cartilage surface
  • Have severely weakened or missing (insufficient) bone in the glenoid
  • Have severely torn rotator cuff tendons and arthritis

Sometimes, surgeons decide on the type of surgery at the time of surgery.

What is resurfacing hemiarthroplasty?

Resurfacing hemiarthroplasty involves replacing only the articular surface of the humeral head with a stemless head-like prosthesis. It offers an alternative for those with shoulder arthritis, with the advantage of bone preservation. Resurfacing hemiarthroplasty may be an option for patients who:

  • The glenoid still has an intact cartilage surface
  • There is no recent fracture of the humeral neck or head
  • There is a desire to preserve the humeral bone

For young or very active patients:

  • This patient group eliminates the risk of component (implant part) wear and loosening that can occur with traditional total shoulder replacements.
  • It may be easier to convert to a total shoulder replacement later if necessary.

How is total shoulder replacement surgery performed?

A standard total shoulder replacement involves replacing the arthritic joint surfaces with a polished metal ball (head) and a plastic socket. These components come in a variety of sizes and can be cemented or press-fitted to the bone.

If the bone is of good quality, your surgeon may choose to use an uncemented (press-fit) humeral component. If the bone is soft, the humeral component can be set with bone cement. In most cases, a plastic (polyethylene) glenoid (socket) component is set with bone cement.

A socket replacement is not recommended in the following cases:

  • Has good cartilage
  • Has severely deficient glenoid bone
  • Has torn rotator cuff tendons and cannot be repaired

When is a reverse total shoulder replacement performed?

Another type of shoulder replacement is called a reverse total shoulder replacement. A reverse total shoulder replacement is used for the following patients:

  • Have completely torn rotator cuffs with severe arm weakness
  • Have severe arthritis and rotator cuff tear arthropathy
  • Have had a previous failed shoulder replacement surgery
  • Have severe humeral head fractures with or without underlying arthritis

For these patients, a traditional total shoulder replacement may cause pain. They may also be unable to lift their arms higher than a 90° angle. Not being able to lift your arm from the side can be seriously debilitating.

In a reverse total shoulder replacement, the socket and ball are swapped. 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 their deltoid muscle to lift their arm instead of a torn rotator cuff.

How to Prepare for Surgery

Medical Evaluation: If you decide to have shoulder replacement surgery, your orthopedic surgeon may want you to schedule a complete physical exam with your family doctor a few weeks before your surgery. This is necessary to ensure that you are healthy enough to undergo surgery and complete your recovery. Many patients with chronic medical conditions, such as heart disease or kidney disease, also need to be evaluated by a specialist, such as a cardiologist or nephrologist, before surgery.

Medications: Be sure to talk to your orthopedic surgeon about any medications you are taking. Some medications may need to be stopped before surgery. For example, the following over-the-counter medications can cause excessive bleeding and should be stopped 2 weeks before surgery:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen
  • Most arthritis medications
  • If you are taking blood thinners, your doctor will advise you to stop these medications before surgery.

FREQUENTLY ASKED QUESTIONS ABOUT SHOULDER PROSTHESIS

  1. What are the complications of shoulder replacement surgery?

Your orthopedic surgeon will explain the possible risks and complications of shoulder joint replacement, including those related to the surgery itself and those that may arise over time after your surgery.

When complications do occur, most can be treated successfully. Possible complications include:

Infection: Infection can occur in the shoulder joint replacement, in the wound, or around the replacement. This can occur while you are in the hospital or after you go home, or even years later. Small infections in the wound area are usually treated with antibiotics. Large or deep infections may require further surgery and removal of the replacement.

Prosthesis Problems: Although prosthesis designs and materials and surgical techniques continue to improve:

  • The prosthesis can wear out and components (parts) can loosen from the bone.
  • The components (parts) of a shoulder replacement can become dislodged. Excessive wear, loosening, or dislocation may require additional surgery (revision).

Nerve damage: The nerves in the area of ​​the joint replacement can be damaged during surgery, but such injuries are rare. These nerve injuries usually heal over time.

Fractures: When you have a prosthesis attached to your bones, the bones around the prosthesis can weaken, and you may experience a stress fracture in the bones surrounding the prosthesis. These stress fractures can cause serious complications.

Home Planning: Making changes to your home before surgery can help your recovery. It will be difficult to reach high shelves and cabinets for the first few weeks after your surgery. Make sure to walk around your home before your surgery and place items you may need on low shelves afterward.

When you get home from the hospital, you will need help with some daily tasks, such as dressing, bathing, cooking, and laundry, for a few weeks.

  1. What is the postoperative process like?

  • You will usually stay in the hospital overnight for observation. Some patients with other health problems (such as heart disease, diabetes) or who have limited assistance at home may need a longer hospital stay and/or inpatient rehabilitation.
  • Your medical team will give you antibiotics to prevent infection.
  • Most patients can eat solid foods and get out of bed the day after surgery.
  • You will feel some pain after surgery. This is a natural part of the healing process.
  • Most patients can perform simple activities such as eating, dressing, and grooming within 2 weeks after surgery.
  • Some pain during activity and at night is common for several weeks after surgery.
  • You should not drive for 2 to 6 weeks after surgery.
  • Pain management is an important part of your recovery. Beginning physical therapy immediately after surgery will help facilitate this. When you have less pain, you can move around sooner and regain your strength more quickly.
  • The success of your surgery will depend largely on how well you follow your orthopedic surgeon’s instructions at home during the first few weeks after surgery.
  1. What is the rehabilitation program after shoulder replacement?

A careful and well-planned rehabilitation program is critical to the success of shoulder replacement. You will usually begin light physical therapy immediately after surgery. Your surgeon or physical therapist will provide you with a home exercise program to strengthen your shoulder and increase your flexibility. Exercise is a critical component of home care, especially during the first few weeks after surgery.