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Total Shoulder Replacement

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  • Overview
  • Procedure Details
  • Risks / Benefits
  • Recovery & Outlook

Overview

The shoulder joint, one of the most complex joints in the body, is essentially a ball and socket joint. However, unlike the ball and socket joint of the hip, the shoulder has much greater mobility. This mobility depends on an elaborate array of muscles, tendons and ligaments, which make up the shoulder.

Shoulder Anatomy

The socket of the shoulder, or glenoid, is part of the scapula (shoulder blade). The ball is on the top end of the arm bone (humerus). With the help of the muscles of the shoulder (the deltoid and rotator cuff muscles), the humerus moves and rotates within the socket raising and twisting your arm.

Arthritis

The most common source of shoulder pain is arthritis. In fact, more than 40 million people in the United

States suffer from some sort of arthritis. There are four main types of arthritis.

  1. Osteoarthritis (or “wear and tear” arthritis) occurs when the smooth tissues on the joint surfaces (cartilage) break down leaving the underlying bone to grind on bone. Not only does this lead to popping and catching sensations and loss of shoulder motion but it can also be quite painful.
  2. Rheumatoid arthritis is a systemic (whole body) disease in which all joints are susceptible. More commonly seen in women, rheumatoid arthritis is a result of the body’s immune system creating chemicals which attack and destroy the joint surfaces.
  3. Traumatic arthritis may occur when the joint is injured from a fracture, ligament tear, or dislocation which may lead to disruption of the normally smooth joint surface. This joint is then more susceptible to arthritis.
  4. Rotator cuff arthopathy is a special category of arthritis that occurs in the presence of a massive, irreparable rotator cuff repair.

Procedure Details

Shoulder replacement surgery essentially involves replacement of the worn out joint surfaces. There are several shoulder replacement implant types which are designed to address different patient needs, anatomy and arthritis type. Also, there are many different factors your surgeon will weigh to select the correct type of replacement for your shoulder. What works well for another patient may not be the best choice for your shoulder.

Standard Shoulder Replacement

In a standard shoulder replacement, the worn, bony ball is replaced with a metal ball and the worn socket is resurfaced with surgical-grade plastic. This restores a smooth bearing surface to the shoulder typically resulting in dramatic pain relief and gradual restoration of motion. Occasionally the socket has too much wear to accommodate the plastic resurfacing and in these cases only the ball may be replaced which still reduces pain and improves function. Normal function after shoulder replacement requires a healthy rotator cuff which, surprisingly, most people with severe arthritis have.

Reverse Shoulder Replacement

In some cases, the rotator cuff is also degenerated or damaged. A standard shoulder replacement is not recommended for these patients as the joint won’t function properly and the prosthesis can wear much more quickly. Reverse shoulder replacement was designed for these patients. In this procedure, a metal ball is attached to the former socket and a plastic “cup” is placed where the native ball used to be on the humerus. This allows for function and durability in the absence of a functioning rotator cuff.

Risk/Benefits

The complication rate following shoulder replacement surgery is low. Serious complications, such as joint infection, occur in fewer than two percent of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. As with any invasive procedure there is some risk of the following conditions:

  • Bleeding
  • Dislocations prosthetic shoulder
  • Fractures
  • Loosening of the replaced shoulder—
  • note that some development
  • of wear is expected after years of use
  • Infection
  • Temporary or permanent nerve and blood
  • vessel injuries
  • Damage to other tissues or fracture
  • Loss of limb or function
  • Anesthetic complications, including death
  • Need for further surgery

Although implant designs and materials, as well as surgical techniques, have been improved, wear of the bearing surfaces or loosening of the parts may occur. Discuss your concerns thoroughly with your orthopedic surgeon prior to surgery.

Going Through with Surgery

Realistic Expectations About Shoulder Replacement Surgery

If you do choose to have shoulder surgery, keep a realistic mindset about the treatment. You will have to put in work and carefully follow your surgeon’s rehabilitation plan for up to a year to ensure the best results. Patients do commonly experience pain, weakness, and limited motion immediately following surgery, but these will improve over time with proper rehabilitation.

Complications

Complications from total shoulder replacement surgery are quite rare. Shoulder replacement problems may include stiffness, slippage of the ball from the socket, problems with glenoid tissue, post-operative infection, and/or nerve damage.

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