While shoulder replacement procedures are not nearly as common as, say, hip or knee replacements, they are still highly effective when it comes to easing joint pain. The first shoulder replacement procedures began in the 1950s in the U.S., but were then only used to treat serious shoulder fractures. Now in modern times, however, this procedure is used worldwide and treats far more than just fractures. The conditions treated by shoulder replacement surgery include the following:
- Arthritis, such as rheumatoid and conditions caused by trauma
- Damage from rotator cuff tear arthropathy (a blend of advanced arthritis conditions and a large tear in the rotator cuff)
- Osteoarthritis (a degenerative disease of the joints)
- Shoulder replacement surgery that failed
- Osteonecrosis (also known as avascular necrosis)
- Serious shoulder fracture
Anatomy of the Shoulder
The human shoulder consists of a ball and socket connection, where the top of the humerus (bone of the upper arm) forms a joint with the glenoid (socket in the shoulder blade). The surfaces of these connecting bones are coated in smooth cartilage that supports the shoulder and enables it to have a broader range of motion.
Reasons for Shoulder Replacement
A list of conditions that shoulder replacement surgery can treat were listed above, but now it’s time to go a little more in depth.
Osteoarthritis (also referred to as “wear and tear” arthritis) is one of the most common conditions that can result in a shoulder replacement procedure. This condition involves the gradual deterioration of the cartilage in the shoulder, and this results in decreased mobility and function. The shoulder can eventually become stiff and increasingly painful as a result. There is unfortunately no cure for the condition, but shoulder replacement surgery can certainly help lessen pain and improve range of motion.
Bad shoulder fractures from hard falls or other accidents are also relatively common reasons for shoulder replacement surgery. Especially in patients who already have osteoporosis, fractures can have a very hard time healing. In cases like these, going ahead with the replacement is far better than attempting to set the pieces of bone and fix an already worn-down shoulder.
Rotator cuff tear arthropathy is another reason for shoulder replacement. This happens when rotator cuff tears cause certain changes in the shoulder, often leading to further damage and arthritis. A type of replacement procedure called “reverse total-shoulder replacement” may be performed here.
Another kind of condition called “avascular necrosis” may require shoulder replacement. In this condition, the top of the humerus loses its blood supply and essentially “dies” as a result. Though anyone can get this condition, people can put themselves more at risk with severe fractures, regular steroid use sickle cell anemia and alcohol and drug abuse, among other things.
Symptoms to Watch Out For
Since arthritis is essentially the root of the conditions that result in shoulder replacement surgery, it is important to know its symptoms:
- Deep pain or aching feelings in the shoulder
- Pain that intensifies with activity (though it may get worse in general over time)
- Pain that gets in the way of sleep
- Grinding noises or sensations in the shoulder, especially during movement
- Locking or “catching” of the shoulder
- Gradual loss of mobility
- Shoulder weakness
- Difficulty reaching and/or performing other basic shoulder activities
Shoulder arthritis conditions can be treated in a variety of ways before surgery is used. Your doctor will advise rest, moist heat, ice packs after athletic activity, special exercises and anti-inflammatory medications that can help ease pain. If the arthritis has not progressed much and is still at an early stage, physical therapy can help strengthen the shoulder and keep its range of motion (more advanced arthritic stages may not benefit from this, and in fact it could only worsen symptoms). Meanwhile, injections of corticosteroids into the shoulder joint can help lessen pain (temporarily). This should be done sparingly though.
Shoulder Joint Replacement (Shoulder Arthroplasty):
Should non-surgical treatments not be sufficient, shoulder joint replacement may be the next step. Good candidates for total shoulder replacement surgery are generally those who no longer have adequate space between their shoulder joints (bone-on-bone osteoarthritis) and rotator cuff tendons that are still intact. There are different kinds of replacement procedures or “arthroplasty”. Generally speaking, a “total” shoulder replacement will involve removing the damaged and worn surfaces of the bone and replacing them with a smooth metal ball (complete with a stem) and a socket crafted from sturdy-yet-smooth plastic.
Since every case is different, orthopedic surgeons like Dr. Samimi will have to evaluate each patient’s condition before deciding on the exact type of replacement needed (only experienced surgeons should be performing it in the first place). For example, sometimes the ball of the joint is all that needs replacing (this is called “hemiarthroplasty”). This is a common solution when there is a severe fracture but the socket itself is healthy and functional.
In addition to the aforementioned procedures, another option is “reverse total shoulder replacement”, a procedure meant for patients with severe arthritis in conjunction with a rotator cuff tear that cannot be repaired. Developed by European doctors in the 1980s, this procedure is fairly new. In fact, the Food and Drug Administration did not approve it in the U.S. until 2004.
The image on the left shows rotator cuff tear arthropathy before treatment, and the right shows the same joint after a reverse total shoulder replacement.
Because it is a complex procedure, shoulder replacement surgery is not an outpatient operation. Nevertheless, the majority of patients are able to go home after only a few days of hospital recovery.
Once the operation is over, however, the long recovery process is only beginning. Your surgeon will plan and go over your specific plan and rehabilitation plan with you. Mild physical therapy will usually begin the day following surgery, and you will most likely have your arm secured in a sling for several weeks. Still, many patients find themselves able to return to basic activities (like dressing and eating) in less than two weeks after the procedure.