Shoulder Replacement Surgery

Shoulder arthroplasty, or total shoulder replacement surgery, is less common than hip or knee replacement, but has been an established treatment since the 1950s. 

Originally developed as a way to treat severe shoulder fractures, total shoulder replacement surgery is now most often used to treat conditions with chronic shoulder pain with goals of first reducing pain, and secondarily increasing strength and range of motion in the joint. 

Sauk Prairie Healthcare’s Orthopedic surgeons perform shoulder replacement, reverse shoulder replacement and shoulder resurfacing, providing long-term relief to chronic shoulder pain. 

Shoulder Conditions

Through shoulder replacement surgery an Orthopedic surgeon can address several chronic pain conditions in the shoulder such as shoulder arthritis, severe rotator cuff damage, and avascular necrosis, in which joint degradation is cause by a lack of blood flow to the joint. 

Rheumatoid arthritis is a condition caused by the body’s immune system attacking the tissue between the bones of a joint, causing pain and swelling with increased friction within the joint. Post-traumatic arthritis is a chronic loss of cartilage and wearing down of a joint as a long-term result of a previous injury. 

The most common form of arthritis and most frequent condition resulting in joint replacement is osteoarthritis, or degenerative joint disease. Known as the wear-and-tear form of arthritis, it develops over the course of years, with wearing down of the cartilage until there is increased friction and bone-on-bone contact, which consequently causes more irritation and inflammation in the joint. 

Joint replacement surgery is generally recommended in more severe cases of late-stage or end-stage arthritis after attempts have been made to treat symptoms with other non-invasive approaches. Appropriate shoulder replacement candidates often experience: 

  • Severe pain interfering with daily activity
  • Persistent pain while at rest, regularly interrupting sleep
  • Lost range of motion and joint weakness
  • Lack of improvement despite other treatments 

An Orthopedic surgeon will often inspect the joint with imaging such as an X-ray or MRI, looking for wear of cartilage, damage to the bone, and specifically loss of space between the upper arm (humerous) and socket (glenoid), where there should be space and soft tissue coverage allowing for smooth movement. 

Total Shoulder Replacement

A total shoulder replacement is really a bone and cartilage replacement with an artificial surface. The shoulder itself is not replaced, as is commonly thought, but rather an implant is inserted on the bone ends. This is done with a metal alloy on the humerus and plastic spacer on the glenoid. This creates a new, smooth cushion and a functioning joint that can reduce or eliminate pain. Sometimes a reverse shoulder replacement is indicated for various reasons, including torn rotator cuff. 

Shoulder joint replacement procedures have an estimated success rate of over 90% with replacement joints often lasting many years.  

Results will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, the patient's activity level, and the patient's adherence to the doctor's orders. Generally, patients have significant relief from pain. Patients can also experience improved range of motion and can often have an easier time doing normal activities.  

Reverse Shoulder Replacement

The explosion in the number of total shoulder replacement surgeries had previously done little to help those with severe rotator cuff injuries, but now the reverse total shoulder replacement has given those patients an option to escape chronic shoulder pain. 

In a traditional total shoulder replacement surgery, the ball-and-socket joint of the shoulder are replaced with an artificial ball grafted onto the top of the arm, and the socket component in the shoulder. However, if you don’t have a good rotator cuff, which are the muscles that stabilize the shoulder, and you have arthritis, then a regular shoulder replacement would fail. 

Reverse total shoulder replacement, approved by the FDA in 2003, offers a solution. A hemisphere is installed on the shoulder blade, while a socket joint is attached to the top of the arm bone. 

Following a reverse total shoulder replacement, the joint is powered by the deltoid muscle instead of the rotator cuff. There are a number of special cases in which a reverse total shoulder replacement can provide relief: 

  • Irreparable torn rotator cuff
  • Cuff tear disease, referred to as arthropathy
  • An unsuccessful previous replacement
  • Severe shoulder pain and difficulty lifting your arm away from your side or over your head
  • Complex fracture of the shoulder joint
  • Chronic shoulder dislocation
  • Tumor of the shoulder joint 

The reverse total shoulder replacement procedure has been shown to deliver improved results for patients with severe rotator cuff damage, but initially carried a higher rate of complications than the traditional replacement. 

The most common complication, according to a 2010 study at the University of Zurich, was scapular notching — an erosion of the scapular neck due to impingement of the rim of the cup of the joint. That could also be prevented, according to the study, by use of larger implant components and shifting the positioning of the implant. 

Haematoma, a swelling of a blood clot, the study noted, was a common issue, but that it was one that could be better controlled. 

Following years of advancement in techniques and technology, the risks of the procedure have been reduced, as the long-term reliability of new joints have improved for those suffering from some of the most extensive cases of joint damage. 

Shoulder Resurfacing

Shoulder resurfacing, also called resurfacing hemiarthroplasty, is a treatment option in which the humerus, or arm bone, is mostly kept intact. 

Shoulder resurfacing was introduced in the late 1950s, but has changed over time, and some studies show positive results for the right patient. 

Shoulder resurfacing involves removing the humerus from the socket of the shoulder joint, resurfacing the ball of the joint with a metal cap, and replacing the bone into the joint. It is a narrowly targeted procedure typically for patients who are younger than other typical joint replacement candidates, who still have a normal amount of cartilage covering their joint socket, and who have a reasonable healthy rotator cuff. 

Another factor is that it might be recommended for patients who may be anticipating repeated surgery later in life. 

Features of the procedure include minimal bone resection, meaning the least amount of bone is removed, as opposed to total replacement, in which the ball is taken from the end of the arm. In resurfacing, there is less chance of the humeral canal, which carried nutrients through the arm, being affected, and less chance of a peri-prosthetic fracture, in which a bone fracture is caused by an attached implant. 

Because there is minimal bone damage during the procedure, there are more options for revision or replacement if there is a problem with the prosthesis. 

Rehabilitation After Shoulder Replacement

After shoulder replacement surgery patients often go home one day later with instructions to manage post-operation swelling and soreness. 

The patient will often be wearing a sling most of the time for four to six weeks after surgery. During this time the patient will also begin a rehabilitation program involving regular appointments with a physical therapist and a strength and flexibility routine for home. 

What to Expect of Shoulder Replacement at Sauk Prairie Healthcare

The Orthopedic surgeons at Sauk Prairie Healthcare specialize in joint replacement procedures and can help guide you through appropriate options to treat chronic shoulder pain. 

If conservative treatments are proving ineffective and shoulder pain is continuing to interfere with your quality of life, your doctor may refer you to see a specialist at Sauk Prairie Healthcare, who work in a team to treat patients. After diagnosis, joint replacement specialists guide patients through initial education about the process, preparation, the surgery itself, followed by the lengthier process of recovery and follow-up. 

Our Orthopedic Surgeons:
Andrew Ertl, MD
Matthew Hebert, MD
Diana Kruse, MD
Michael Lamson, MD
David Marcu, MD

References:

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