Total shoulder replacements are not nearly as common as a total hip or knee replacement, but are just as efficient in relieving joint pain. A total shoulder replacement may be necessary when the pain and function of your shoulder is no longer allowing you to have a great quality of life and non-surgical or less invasive surgical options are not able to help you.
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, which means the ball of the upper arm fits into a shallow socket (glenoid) in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint. To help your shoulder move easier, synovial fluid lubricates the shoulder capsule and joint.
- Osteoarthritis (Degenerative Joint Disease): This type of arthritis is age-related and usually occurs in people 50 years and older; however, younger people can also be affected by osteoarthritis. The cartilage that cushions the bones in the shoulder soften and wear away. This causes the bones to rub against one another, which makes the shoulder joint painful and stiff.
- Rheumatoid arthritis: The synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation damages the cartilage and eventually causes cartilage loss, pain and stiffness in the shoulder. This is the most common form of a group of disorders referred to as inflammatory arthritis.
- Post-traumatic arthritis: This can follow a serious shoulder injury or fracture. The cartilage may become damaged and lead to shoulder pain and stiffness overtime.
- Rotator cuff tear arthropathy: A large, long-standing rotator cuff tear can develop cuff tear arthropathy, which can lead to arthritis and destruction of the joint cartilage.
- Avascular Necrosis (Osteonecrosis): A painful condition that occurs when the blood supply to the bone is disrupted. This can ultimately cause destruction of the shoulder joint and lead to arthritis. Steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease and heavy alcohol use are risk factors for osteonecrosis.
- Severe Fractures: When the head of the upper arm bone is shattered, it can be difficult for a physician to put the pieces of the bone back in place. This is when a shoulder replacement may be necessary.
- Loss of motion/weakness of the shoulder
- Severe shoulder pain that interferes with everyday activities- from bathing to simple house chores
- Moderate to severe pain while resting, often affecting sleep
To determine if you need a total shoulder replacement, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. An X-ray will be obtained and a CT scan or MRI may be necessary to rule out other problems.
There are different types of shoulder replacements. Your physician will evaluate your specific situation and determine the best replacement for you.
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a 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).
Surgical options include:
- Total Shoulder Replacement: Involves replacing the arthritic joint surface with a highly polished metal ball attached to a stem and a plastic socket. You will be fitted to ensure the metal ball works for your shoulder.
Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are good candidates for this procedure.
- Reverese Total Shoulder Replacement: The socket and metal ball are switched so the metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the rotator cuff to lift the arm.
Patients with completely torn rotator cuffs with severe arm weakness or have severe arthritis and rotator cuff tearing are good candidates for this surgery. It may also be necessary for patients who had a previous shoulder replacement fail.
- Stemmed Hemiarthroplasty: The head of the humerus is replaced with a metal ball and stem, similar to a traditional shoulder replacement; however, no socket is used.
Patients with a severely fractured humeral head but normal socket may undergo this type of surgery. Additionally, arthritis that only involves the head of the humerus, shoulders with severely weakened bone in the glenoid and some shoulders with severely torn rotator cuff tendons and arthritis may also undergo this surgery.
- Resurfacing Hemiarthroplasty: Involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a steam.
Generally younger patients with an intact cartilage surface of the glenoid, no fresh fracture of the humeral neck or head and a desire to preserve humeral bone may undergo this surgery.
Most shoulder replacement surgeries require a one or two night stay in the hospital. Physical therapy will start right away but it will not be too intense. Primarily, a physical therapist will move your arm with you to keep your shoulder loose as it heals. The physical therapist will also show you simple exercises you can do once you leave the hospital.
Total recovery after surgery can take several months. However, you should be able to get back to your daily activities in a few weeks.