A total shoulder replacement, also called arthroplasty, is a surgery used when a patient’s shoulder is severely damaged by arthritis causing daily activities to become hard to perform. A patient’s arthritis can often progress to a point where there is pain and weakness with simple tasks and even resting. Shoulder replacement surgery can help to relieve pain, restore function and make an impact in a patient’s life. Annually, there are 53,000 shoulder replacement procedures performed in the US. With new innovations and advancements, shoulder replacements have continued to improve over the past decade with more capabilities than ever before.
The shoulder is the most mobile joint in the body. The joint is formed at the junction of three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The shoulder is a ball and socket joint where the head of the humerus rests in a socket in the shoulder blade called the glenoid. These bones are all lined with articular cartilage, which protects the joint as well as reduces friction in the shoulder. Shoulder arthritis or the painful inflammation and stiffness of the shoulder joint causes degeneration of the shoulder. There are three major types of arthritis. Osteoarthritis is the wear and tear of the cartilage of the shoulder over time and Rheumatoid arthritis is an autoimmune disease causing chronic inflammation and cartilage degeneration in the shoulder. Lastly, Post-traumatic arthritis is caused when a serious shoulder injury, like bone fractures or rotator cuff tears, damages the cartilage of the shoulder over time.
At the time of your appointment, the surgeon will take a detailed history, perform a physical exam, and take x-rays of your shoulder. From these x-rays, the severity of degeneration can be assessed. Treatment plans and outcomes will be discussed at this time and a plan will be put into place.
Conservative treatment of shoulder arthritis is almost always exhausted before a total shoulder replacement is considered. Treatment plans include injections, medication, weight loss, physical therapy, and strengthening. Shoulder replacement surgery is not a decision to be taken lightly and needs planning, commitment, and rehabilitation to have a successful and positive outcome.
Surgical management of severe shoulder arthritis can involve multiple options depending on your specific condition, which will be discussed prior to surgery. Regardless of which type of shoulder replacement surgery is performed, during surgery the damaged bone and cartilage of the shoulder are removed, resurfaced, and replaced with an artificial shoulder joint. For arthritic patients with an intact rotator cuff, a total shoulder replacement is optimal where a metal ball with an attached stem and plastic socket are implanted into the joint. For patients with arthritis that only involves the humerus, a partial or hemiarthroplasty can be recommended where only part of an artificial joint is implanted. Lastly, for arthritic patients that also have a completely torn rotator cuff, a reverse shoulder replacement may help to reduce pain and improve function to the shoulder. These procedures are often done as an outpatient surgery or in combination with a short hospital stay. The goal of this procedure is for the patient to successfully return to daily activity with improvement in symptoms and a better quality of life in 6-9 months. A general guideline of Shoulder Replacement rehabilitation can be found within the Rehabilitation Protocols.