What is Shoulder Replacement? Complications, Types and Procedure.

INTRODUCTION:

Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain.

Shoulder replacement surgery was first performed in the 1950s to treat severe shoulder fractures.  Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis.

If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery.

SHOULDER JOINT:

The shoulder is made up of three bones:  the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint.  The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade.  This socket is called the glenoid.

The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.  A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint.  In a healthy shoulder, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder.

The muscles and tendons that surround the shoulder provide stability and support.

All of these structures allow the shoulder to rotate through a greater range of motion than any other joint in the body.

SHOULDER REPLACEMENT:

In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components called the “prosthesis.”  The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).

Candidate for a Shoulder Replacement: 

While there are no age and weight limits, advanced age and obesity do tend to increase the risk for post-surgical complications such as infection. 

Nicotine use has been shown to inhibit healing following rotator cuff repairs.

Surgery Recommendation:   

There are several reasons why your doctor may recommend shoulder replacement surgery.  People who benefit from surgery often have:

  1. Severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
  2. Moderate to severe pain while resting.  This pain may be severe enough to prevent a good night's sleep.
  3. Loss of motion and/or weakness in the shoulder.
  4. Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.

 

Surgery Consideration:  For patients who have: 

  1. Osteoarthritis:  Arthritis, usually due to ageing.
  2. Rheumatoid arthritis:  Arthritis, due to chronic inflammation (autoimmune disease). 
  3. Post-traumatic arthritis:  Arthritis, following trauma to the shoulder ligaments or tendons.
  4. Avascular necrosis:  Destruction of humeral head due to lack of blood supply (due to dislocation, or fracture, or shoulder diseases).
  5. Rotator cuff tear arthropathy following a large, long-standing rotator cuff tear, causing joint cartilage destruction.
  6. Severe fracture of the shoulder is another common reason for people to opt for shoulder replacement.
  7. Failed previous shoulder replacement surgery due to implant loosening, wear, infection, and dislocation.

Types of Shoulder Replacement:

Traditional Total Shoulder Replacement:

The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

These components come in various sizes.  They may be either cemented or "press fit" into the bone.  If the bone is of good quality, your surgeon may choose to use a non-cemented (press-fit) humeral component.  If the bone is soft, the humeral component may be implanted with bone cement.  In most cases, an all-plastic glenoid (socket) component is implanted with bone cement.

Implantation of a glenoid component is not advised if:

  1. The glenoid has good cartilage
  2. The glenoid bone is severely deficient
  3. The rotator cuff tendons are irreparably torn.

The patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Stemmed Hemiarthroplasty:

Depending on the condition of the shoulder, the surgeon may replace only the ball. This procedure is called a hemiarthroplasty.  In a traditional hemiarthroplasty, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty.  This is done for severely fractured humeral head, arthritis, very weak glenoid, and severely torn rotator cuff tendons. 

Resurfacing Hemiarthroplasty:

Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a stem.   This is done in young and active patients with a good glenoid cartilage and no fresh fracture of the head.

Reverse Total Shoulder Replacement:

Another type of shoulder replacement is called reverse total shoulder replacement.  Reverse total shoulder replacement is used for people who have:  completely torn rotator cuffs with severe arm weakness; cuff tear arthropathy; and failed previous shoulder replacement.

COMPLICATIONS:

For shoulder replacement surgery, the complications may include:

  1. Infection [fever greater than 100 F (37.8 C); shaking chills; drainage from the surgical site; increasing redness, tenderness, swelling and pain in the shoulder].
  2. Prosthesis problems of loosening and implant wearing out.
  3. Nerve and blood vessel injury.
  4. Continued pain.

POSTOP CARE:

In the hospital, pain management and rehabilitation are addressed.  At home, wound care, diet, and activity are advised.

DO’S AND DON’T’S:

  1. Don't use the arm to push yourself up in bed or from a chair.
  2. Do follow the program of home exercises prescribed for you.
  3. Don't overdo the exercises. 
  4. Don't lift anything heavier than a glass of water for the first 2 to 4 weeks after surgery.
  5. Do ask for assistance.
  6. Don't participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.
  7. Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.

Tags: Shoulder Replacement , shoulder joint , Fracture , Joints , Joint Pain

 

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