Total Shoulder Replacement
This surgery replaces the damaged or diseased head of the humerus (also called the ball) and cartilage from the shoulder joint with a metal and plastic joint.
Total shoulder replacement surgery involves replacing the damaged joint with an artificial one. The ends of the upper arm bone (humerus) and the shoulder bone may be removed and replaced with artificial devices lined with either metal or plastic. The artificial shoulder joint components are then held together with a special surgical cement. By removing the injured joint and replacing it with an artificial one, total shoulder replacement surgery can help restore painless motion and allow the patient to resume normal daily activities.
Reasons for Total Shoulder Replacement Surgery
Total shoulder replacement surgery is most commonly used to treat patients with conditions that produce pain in the shoulder and a limited range of motion. This may include:
- Osteonecrosis, or avascular necrosis, a bone disease caused by a reduced blood flow to the bones in a joint. The disease may eventually result in a weakening or breaking down of the bones over time.
- Torn rotator cuffs
- Rheumatoid arthritis
Candidates for Total Shoulder Replacement Surgery
Patients who have severe cases of osteoarthritis, rheumatoid arthritis, avascular necrosis or torn rotator cuffs are generally considered good candidates for total shoulder replacement surgery. These individuals usually experience symptoms such as pronounced pain, limited range of motion, stiffness and swelling in the shoulder area. Total shoulder replacement surgery can significantly improve the symptoms of these conditions and restore fuller function to the shoulder.
Total shoulder replacement surgery, however, may not be the best procedure for patients who have osteoporosis, a disorder that causes bones to become fragile and more likely to fracture. In addition, patients with existing health conditions, including heart disease, kidney disease and diabetes, are considered at greater risk for complications following the surgery. Elderly individuals also may not be good candidates for the surgery, since bones tend to become progressively weaker with age, which can increase the risks associated with this procedure.
The Total Shoulder Replacement Surgery Procedure
Total shoulder replacement surgery is performed in a hospital setting with the patient under general anesthesia. The surgery usually takes about two hours to complete. It may be performed either arthroscopically, using several tiny incisions, or through an open procedure, which requires a longer incision.
During the surgery, the doctor will replace the end of the damaged upper arm bone and, in most cases, the shoulder bone, with artificial devices lined with either plastic or metal. If the surface of the shoulder bone has also been damaged, the area will be cleaned and the problematic portions are smoothed away. All of the replacement joint components are then secured in place with either surgical cement or a similar stabilizing material.
Recovery from Total Shoulder Replacement Surgery
After the procedure is complete, patients are usually required to spend one to two days in the hospital. Physical therapy will likely be necessary to restore full joint function. Antibiotics and pain medication are administered as needed following total shoulder replacement surgery to reduce the chance of infection or post-surgical pain. Patients will also be restricted from strenuous activities for about 6 weeks and need to avoid placing pressure on the surgical shoulder.
Risks of Total Shoulder Replacement Surgery
While total shoulder replacement surgery has been performed successfully for many years, there are certain complications associated with any surgical procedure. Possible risks may include:
- Blood clots
- Persistent joint instability
- Nerve injury
- Dislocation or eventual loosening of the artificial joint
- Fracture of the upper arm bone
- Less than full range of motion within the joint
- Poor wound healing
Results of Total Shoulder Replacement Surgery
Total shoulder replacement is often a very effective procedure, but as with any surgery, that is not always the case. Most patients will experience an improvement in their symptoms and be better able to perform daily activities. However, there are some patients who may never regain the same level of joint function they had prior to their surgery. In addition, total shoulder replacement surgery may fail to provide adequate pain relief for certain individuals. If the results are not as positive as had been expected, reverse total shoulder replacement may be an option to correct the problems within the shoulder.