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Shoulder Replacement

The surgical removal of the damaged areas of the shoulder joint and their replacement with artificial components, called a prosthesis, is known as shoulder replacement surgery or shoulder arthroplasty.

The shoulder joint is a ball-and-socket type of joint. The humerus (round head of the upper arm bone) fits into a glenoid socket (shallow socket in the shoulder).
The prosthesis used for a shoulder replacement surgery is made up of two parts:
A metal ball (made of stainless steel) is attached to a stem (made of titanium) to keep the ball attached to the arm.
A polyethylene cup for replacing the glenoid socket.

Types:

  1. Hemiarthroplasty: This procedure involves replacing the ball and stem.
  2. Resurfacing hemiarthroplasty: This procedure involves replacing the joint surface of the humeral head with a cap-like prosthesis. 
  3. Anatomic total shoulder replacement: This procedure involves replacing an arthritic joint with a highly polished metal ball.
  4. Stemless total shoulder arthroplasty: This procedure involves attaching a metal ball to the upper arm without a stem.
  5. Reverse total shoulder replacement involves the placement of a metal ball in the place of the glenoid socket and attaching a plastic cup to the stem to move it to the humerus.

Symptoms

Purpose:
A shoulder replacement surgery may be performed in the following cases:

  • Osteoarthritis or wear-and-tear arthritis (wearing down of the protective tissue at the bone ends, known as the cartilage)
  • Rotator cuff (group of muscles and tendons that surround the shoulder joint) injuries
  • Fractures of the humerus (due to the failure of previous surgery for fracture fixation or an injury)
  • Rheumatoid arthritis (a chronic inflammatory disorder in which the immune system of the body attacks the joints and internal organs)
  • Osteonecrosis (death of bone tissue due to reduced blood supply)
  • Other inflammatory conditions 

Symptoms:
The following symptoms may indicate the need for a shoulder replacement surgery:

  • Severe shoulder pain
  • Shoulder stiffness
  • Pain limiting everyday activities like bending or walking
  • Inability to move or lift 
  • Severe pain that is not relieved by the use of anti-inflammatory medications or drugs
  • Shoulder joint fracture

Diagnosis

The following tests and diagnostic methods are used in order to diagnose problems with the shoulder bone:

  • Medical history- the orthopedic surgeon would ask questions about the patient’s general health, family history, severity and extent of pain, the extent to which the condition inhibits physical activity etc.
  • Physical exam- the doctor would conduct a physical exam to check for shoulder alignment, strength or stiffness. Shoulder's mobility and range of motion will also be checked.
  • X-rays- X-rays would help in determining the extent of damage or deformity by looking for structural changes, signs of joint erosion, cartilage loss or tissue tear, inflammation etc.
  • Other tests- other tests such as a magnetic resonance imaging (MRI) scan may also be needed to determine the condition of the bone of the shoulder.

Treatment

  • The procedure is generally done under general anesthesia, that is, the patient is put to sleep during the procedure.
  • A 4 to 10 inches long incision is made near the shoulder area.
  • The damaged bone and attached cartilage are now cut out.
  • The shoulder blade socket is then resurfaced.
  • The shoulder joint is replaced using a plastic or metal prosthesis.
  • The procedure takes approximately two to three hours to complete.

 

Risks

The following complications can occur due to a shoulder replacement surgery:

  • Shoulder joint dislocation 
  • Bone fracture
  • Implant prosthesis loosening 
  • Rotator cuff muscles failure 
  • Nerve damage
  • Blood clot formation
  • Bleeding
  • Infection 
  • Allergic reaction to the anesthesia 
  • Pain that does decrease or go away
  • Need for another surgery

 

After Procedure

  • The patient generally goes home one to three days after the surgery. 
  • The patient is prescribed pain-relieving medications to ease the pain and discomfort after the procedure.
  • Physiotherapy is provided to the patient in the hospital to prevent the stiffness of the muscles around the shoulder region.
  • The patient will be taught how to move around the operated arm by using the non-operated arm.
  • The operated arm needs to stay in a sling for two to six weeks after the surgery. 
  • The patient is instructed to avoid lifting heavy objects and performing strenuous activities involving pulling or pushing after the surgery.
  • Most patients are able to resume their daily activities two to six weeks after the procedure.
  • The patient is instructed to avoid driving for about six weeks after the procedure.
  • Home exercises are taught to the patient to aid in quick recovery.
  • Vigorous activities like swimming or golfing can be resumed six months after the surgery.

 

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