Shoulder

Shoulder Replacement Orthopedic Surgery Overview

Shoulder Replacement Orthopedic Surgery Overview.

The shoulder joint is the third most frequently replaced joint after the hip and knee, with roughly 50,000 procedures being performed in the United States between 2005 and 2006.

Lack of range of motion and pain are the main reasons patients consider this operative treatment. Whether your pain and limited range of motion is a result of osteoarthritis, a rotator cuff tear or a fracture, it can be very debilitating and can affect normal day-to-day activities.

The first step to returning to an active lifestyle is to make an appointment with your orthopedic surgeon. After a thorough examination, your surgeon will make a recommendation regarding surgery. Generally speaking, you are a candidate if you experience shoulder joint pain that is severe enough to prevent you from carrying out normal daily activities and your pain is not responsive to non-surgical treatments. Chronic shoulder problems can prevent you from enjoying everyday activities, but thanks to today’s advanced technology, you no longer have to live with pain.

Joint replacement surgery is a major operation. As with any major operation, there are possible complications. Some of these are related to anesthesia, while others are associated with the joint surgery itself. Every possible effort is made by the medical team to prevent complications, but this cannot be accomplished without your participation. Therefore, it is important that patients know about the following, which include but are not limited to, infection, blood clots, implant breakage, malalignment, stiffness, dislocation and nerve damage.

Any of these can require additional surgery. Although implant surgery is successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as a patient’s age and activity level can affect longevity. Your surgeon will discuss these and other relevant risks with you.

There are many things that your surgeon will do to minimize the potential for complications. Your surgeon may ask you to see your family physician before surgery to obtain tests to better understand your medical condition.

Common Reasons for Shoulder Replacement:

Osteoarthritis

Osteoarthritis (degenerative arthritis), the most common form of arthritis, affects nearly 21 million people in the United States. It is a condition that causes “wear and tear” to your joint cartilage and develops after years of constant motion and pressure on the joints. As the cartilage continues to wear, the joint becomes inflamed and can result in unbearable pain and decreased range of motion. If non-surgical treatment options such as medication, physical therapy or lifestyle changes fail to provide relief, your surgeon may recommend a surgical treatment, including shoulder replacement.

Treatment: Shoulder replacement surgery replaces the damaged part of your shoulder. Sometimes, only the ball is replaced. Other times, both the ball and socket are replaced. The ball is usually metal and the socket is usually plastic. During surgery, an incision is made in the front of the shoulder. Once your surgeon exposes your shoulder joint, the surgeon will remove the damaged bone and cartilage. The head of the humerus is then removed so your humeral shaft can be prepared for the insertion of the metal stem and ball.

In the case of a total shoulder arthroplasty, the socket (glenoid) portion of your shoulder will also be resurfaced and replaced to re-create the natural contours of the bones in a healthy shoulder. In cases where only the humeral head is replaced, a hemiarthroplasty is performed. Both are options for patients with painful and disabling shoulder joints.

Inflammatory Arthritis

Inflammatory arthritis is a chronic joint disease that can attack any or all joints in the body. It can strike at any age and affects more women than men. In the shoulder, inflammatory arthritis causes the synovium to thicken and form a tissue growth (pannus) that clings to the protective cartilage and releases chemicals that attack and destroy it. The joint may become red and swollen, and pain may radiate into the neck and arm. Over time, the joint may become stiff and the muscles may weaken from lack of use. The bone also may be destroyed.

Treatment: Shoulder replacement surgery is used for inflammatory arthritis sufferers to relieve severe arthritic pain and inflammation that does not respond to medication or physical therapy. Surgery can improve pain and mobility, and is typically done only after age 50 since artificial joints tend to wear down after 10 to 15 years.

Rotator Cuff Tear

Most people with a small cuff tear can be treated arthroscopically.

Surgery for rotator cuff tears usually occurs when a patient has a combination of shoulder arthritis and a massive irreparable rotator cuff tear. The rotator cuff is a group of muscles/tendons (supraspinatus, infraspinatus, teres minor and subscapularis) that surround the shoulder in order to keep the shoulder centered while performing shoulder-related tasks such as elevating and rotating the upper arm.

When a massive rotator cuff tear occurs, pre-operative evaluations usually reveal that the rotator cuff is irreparable or the muscles have atrophied to the point where they can no longer support the shoulder joint. The degenerated muscles lose their ability to keep the humerus centered on the glenoid, causing your arm bone to move upward and out of the socket. This impingement of bone on bone, combined with arthritis and previous shoulder injuries, can cause severe pain with pseudoparalysis (false paralysis) or stiffness of the shoulder.

Treatment: Depending on the severity of the rotator cuff tear, your doctor may opt to perform a reverse shoulder replacement. In this procedure, the anatomy of the shoulder is reversed by attaching a metal ball to the shoulder bone and a plastic socket to the upper arm bone.

Fracture

The upper arm can fracture for a variety of reasons. Proximal humerus fractures are typically caused by trauma-related injuries such as a fall, but become more common in persons around the average age of 60 as they become more prone to osteoporosis. The proximal humerus includes four parts: the articulating surface, the greater and lesser tuberosity, and the humeral shaft. When complex proximal humerus fractures occur, they tend to break off into three or four parts in consistent patterns around the ball-and-socket joint. Fractures are the most severe injuries to the upper humerus and can be difficult to treat.

Treatment: Your surgeon may recommend that you do not have surgery, but instead participate in supervised therapy.

However, operative treatment is the most universal solution for these types of fractures that can be fixed. Depending on the age and severity of the fracture, your doctor may suggest shoulder replacement surgery. In this case, the ball and the upper portion of the humerus will be replaced in order to replicate the anatomy of the shoulder. The procedure usually helps regain shoulder function and reduces the amount of pain.

Avascular Necrosis

Avascular necrosis is a disease in which there is a temporary or permanent loss of blood supply to the bone. A number of conditions, including long-term use of steroids or alcohol, a traumatic injury, rheumatoid arthritis or unhealed fractures can cause the blood supply to the bone to be cut off. As the bone dies, it collapses. Although avascular necrosis can happen in any bone, it usually affects the ends of long bones such as the humerus. When this happens, the shoulder becomes painful and movement becomes limited.

Treatment: The goal of treating avascular necrosis is to improve the use of the joint and to stop it from collapsing further. Treatment options will be based on your condition and may include medication, physical therapy or shoulder replacement surgery.