Shoulder Replacement Surgery
Shoulder replacement surgery is very successful at relieving pain in the shoulder caused by arthritis. It can also be used to treat severe traumatic shoulder fractures and severe rotator cuff tears.
Shoulder arthritis occurs when the cartilage that provides a smooth gliding surface in the shoulder wears out or deteriorates. Arthritis in the shoulder is much less common than in the knee or the hip. However, it can be caused by:
- Simple wear and tear over time (osteoarthritis)
- Inflammatory disease (such as rheumatoid arthritis)
- Rotator cuff arthropathy – This is a condition that occurs in some patients with large long-standing rotator cuff tears that cannot be repaired.
Shoulder arthritis can also be treated nonoperatively. This treatment consists of activity modification, anti-inflammatory medications, and steroid injections. However, some shoulder arthritis may require shoulder replacement surgery
In shoulder replacement surgery, either the entire shoulder is replaced (total shoulder replacement), or just the ball of the shoulder is replaced (hemiarthroplasty). A new type of shoulder replacement known as a reverse total shoulder replacement is also being used with much success. It is primarily designed for patients who have arthritis due to long-standing rotator cuff tears. The choice of shoulder replacement is individualized based on the patient.
Total Shoulder Replacement
Total shoulder replacement involves replacing both the ball and socket of the shoulder joint. This surgery is very effective in relieving pain from arthritis. While shoulder replacements are performed less commonly than knee and hip replacements they are very successful and provide long-term pain relief.
Reverse Shoulder Replacement
A reverse shoulder replacement is suggested for patients with severe rotator cuff tears and/or arthritis. When a large rotator cuff tear is present the humeral head or ball portion of the shoulder tends to move superiorly in relation to the socket. In these situations, if a standard total shoulder replacement is used the socket component tends to loosen.
A reverse shoulder replacement involves placing a socket like component where the ball portion of the shoulder was, and a ball component where the socket was. This allows better motion of the arm when the rotator cuff is not working. Some patients with arthritis, a large rotator cuff tear, or rotator cuff arthropathy cannot lift their arms above their heads. However, after a reverse shoulder replacement this motion will be much improved.
Recovery after a shoulder replacement typically involves one night in the hospital. A sling is also commonly used for the first 4 weeks after shoulder replacement to allow the muscles to heal from the surgery. Gentle range of motion is started the day after surgery, and physical therapy is continued for 2 to 4 months after surgery to improve range of motion and shoulder strength.