Shoulder arthritis is a condition in which the smooth cartilage that covers of the bones of the shoulder degenerate or disintegrate. In a healthy shoulder, these cartilage surfaces permit the bones to comfortably glide against one another. When these cartilage surfaces disappear, the bones come into direct contact, increasing friction and causing them to roughen and damage each other. Bone-on bone movement can be quite painful and difficult.
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.
Conditions that can be treated by Shoulder Replacement ?
2. Rheumatoid Arthritis
3. Post Traumatic Arthritis
4. Severe Comminuted fractures of Proximal Humerus
5. Rotator Cuff tear Arthropathy
Shoulder Replacement Options
Shoulder replacement surgery is highly technical. It should be performed by a surgical team with experience in this procedure.
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.
A total shoulder joint replacement.
These components come in various sizes. They may be either cemented or “press fit” 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.
Reverse Total Shoulder Replacement
A reverse shoulder replacement is a design in which the positions of the ball and socket are switched: A metal ball implant is placed where the patient’s own natural socket was, and a plastic socket implant is placed on the head of the humeral head.
This reverse design has more stability and does not need the tendons to hold it in place. It’s motion is controlled by the deltoid muscle rather than the rotator cuff tendon. This make it an ideal choice when the damaged shoulder needs new surfaces, but does not have sufficiently healthy soft tissues to support stabilization and movement. It is commonly performed on patients who have shoulder arthritis and a severer rotator cuff tear.
Depending on the condition of your shoulder, your surgeon may replace only the ball. This procedure is called a hemiarthroplasty.
Some surgeons recommend hemiarthroplasty when the humeral head is severely fractured but the socket is normal. Other indications for a hemiarthroplasty include:
• Arthritis that 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
• Some 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.
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.
Resurfacing hemiarthroplasty may be an option for you if:
• The glenoid still has an intact cartilage surface
• There has been no fresh fracture of the humeral neck or head
• There is a desire to preserve humeral bone
For patients who are young or very active, resurfacing hemiarthroplasty avoids the risks of component wear and loosening that may occur with conventional total shoulder replacements in this patient population. Due to its more conservative nature, resurfacing hemiarthroplasty may be easier to convert to total shoulder replacement, if necessary at a later time.
Candidates for Surgery
• A completely torn rotator cuff that cannot be repaired
• Cuff tear arthropathy
• A previous shoulder replacement that was unsuccessful
• Severe shoulder pain and difficulty lifting your arm away from your side or over your head
• A complex fracture of the shoulder joint
• A chronic shoulder dislocation
• A tumor of the shoulder joint
• Tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain
This procedure to replace your shoulder joint with an artificial device usually takes about 2 hours.
Your surgeon will make an incision either on the front or the top of your shoulder. He or she will remove the damaged bone and then position the new components to restore function to your shoulder.
After surgery, your medical team will give you several doses of antibiotics to reduce your risk for infection, and pain medication to keep you comfortable. Most patients are able to eat solid food and get out of bed the day after surgery. You will most likely be able to go home on the second or third day after surgery.
When you leave the hospital, your arm will be in a sling. Your surgeon may instruct you to do gentle range of motion exercises to increase your mobility and endurance. A formal physical therapy program may also be recommended to strengthen your shoulder and improve flexibility.
You should be able to eat, dress, and groom yourself within a few weeks after surgery.
Your surgeon may ask you to return for office visits and x-rays in order to monitor your shoulder.
Do’s and Dont’s After Surgery
• Do follow the home exercise program prescribed by your doctor.
• Do avoid extreme arm positions, such as behind your body or your arm straight out to the side for the first 6 weeks.
• Don’t overdo it.
• Don’t lift anything heavier than 5 lbs. for the first 6 weeks after surgery.
• Don’t push yourself up out of a chair or bed, as this requires forceful muscle contractions.
• Don’t participate in repetitive heavy lifting after shoulder replacement.