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Bahri Orthopaedics

Total Shoulder Replacement

Like the hip and knee, joint replacement surgery is performed for the shoulder for conditions such as arthritis, fractures, avascular necrosis, and failed previous joint replacement surgery.  It is much less common than hip and knee replacement surgery (700,000 versus 23,000 in 2002),  but is increasing in frequency. In addition to being less common, shoulder replacement surgery requires special skills and advanced training due the increased complexity associated with this  procedure.

Anatomy

    1. The shoulder is a ball-and-socket joint that enables you to raise, twist and bend your arm.
    2. In a normal shoulder, the rounded end of the upper arm bone (head of the humerus) glides against the small dish-like socket (glenoid) in the shoulder blade (scapula).
    3. The surrounding muscles and tendons provide stability and support.

Figure 1: Cartilage and mechanical deterioration of the shoulder
Figure 1: Mechanical deterioration of the shoulder joint

The joint surfaces are normally covered with smooth cartilage. They allow the shoulder to rotate through a greater range of motion than any other joint in the body.
Arthritis

    1. Conditions like arthritis can lead to loss of the cartilage and mechanical deterioration of the shoulder joint (Figure 1).
    2. The result can be pain, stiffness, and crepitus (grating sound).
    3. This can lead to a loss of strength, decreased range of motion in the shoulder and impaired function.

 

Treatment options

      1. Resting the shoulder and applying moist heat can ease mild pain. After strenuous activity, an ice pack may be more effective at decreasing pain and swelling.
      2. Physical therapy
      3. Arthritis medications, called non-steroidal anti-inflammatory drugs (NSAIDs), can control arthritis pain. Certain NSAIDs may be obtained over-the-counter, while others require a prescription.
      4. Periodic cortisone injections into the shoulder joint can provide temporary pain relief. Excessive cortisone shots can have adverse effects.
      5. Surgery. Shoulder replacement surgery may be needed to relieve pain and restore motion. There are several different types of shoulder replacements. The usual total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket component that is often held in place with small amounts of cement (Figures 2 and 3). Since 2004 (FDA approval), a reverse ball socket design has been used for the treatment of rotator cuff arthropathy (massive rotator cuff tear with arthritis, Figures 4 and 5). Your surgeon should possess additional training and expertise regarding shoulder replacement surgery, particularly when reverse shoulder replacement surgery is a consideration.

Figure 2: Highly polished metal ball attached to a stem
Figure 2: Highly polished metal ball attached to a stem

 

 

 

 

Figure 3: Plastic socket component
Figure 3: Plastic socket component

 

 

 

Figure 4: Reverse ball socket design
Figure 4: Massive rotator cuff tear with arthritis

                          

Figure 5: Reverse ball socket design
Figure 5: Reverse and ball socket design

Rehabilitation

The rehabilitation program is critical to the success of shoulder replacement surgery. Therapy is physician directed and patient maintained. For most cases, you will start gentle pendulum and passive motion exercises on the first day after the operation while as an inpatient. An arm sling is utilized during the day for the first 4 to 6 after surgery. The strengthening phase occurs during the second month after surgery. Even though most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery, such activities as driving a car and weightlifting are not permitted. Patients will continue to demonstrate clinical improvement for 12 to 18 months after surgical intervention.