Shoulder Replacement
When severe shoulder pain and decreased range of motion are keeping you from completing everyday tasks and doing the things you love, it’s time to consult with the orthopaedic surgeons at Kansas Spine & Specialty Hospital regarding arthroplasty, or shoulder replacement surgery.
Symptoms of concern for shoulders include:
- Bones that feel like they are grinding
- Cracking sound when moving the arm
- Difficulty lifting the arm
- Numbness
- Pain that radiates into the elbow, hand or wrist
- Shoulder instability
- Shoulder stiffness
- Soreness
- Tenderness
Our surgeons will assess your symptoms and recommend the appropriate treatment, which may include shoulder replacement surgery. This surgery is meant to relieve your pain, improve your strength, increase your range of motion and enable normal use of your shoulder and arm.
Common Conditions Treated
Shoulder replacement surgery is used to treat many conditions that can damage the joint, including:
- Osteoarthritis – A degenerative condition that is the most common form of arthritis
- Rotator Cuff Injuries – Progressive wear and tear of the shoulder tendon due to repetitive motion or injury
- Fractures – A broken bone in the proximal part of your humerus, scapula or clavicle
- Rheumatoid Arthritis – A chronic inflammatory condition that causes pain, swelling, stiffness and loss of joint function
- Osteonecrosis – Death of bone tissue that results from disruption of the surrounding blood flow
Our surgeons may recommend shoulder replacement surgery if:
- Shoulder pain prevents a person from performing essential everyday tasks
- A person experiences moderate to severe pain while resting, which may affect their sleep quality
- A person has lost mobility or experiences weakness in the shoulder
- Other treatments, such as medications, physical therapy and physical adaptations, have not been effective at reducing pain
An ideal candidate for traditional shoulder replacement generally has significant shoulder pain and dysfunction caused by osteoarthritis or rheumatoid arthritis, where nonsurgical treatments like medication and physical therapy haven’t provided adequate relief. Other conditions like osteonecrosis or severe, untreated fractures can also make someone a good candidate. However, a comprehensive evaluation by a surgeon is crucial to determine if shoulder replacement is the right course of action.
If you are in good overall health, understand the potential benefits and limitations of the surgery, and can be actively involved in your rehabilitation, you may be a candidate for robotic-arm assisted shoulder replacement surgery.
What is Joint Replacement?
During joint replacement surgery, the damaged joint surfaces are replaced with artificial implants designed to replicate the natural joints. The implants may be made of metal, plastic, or a combination of the two. The material used will be based on several factors that include age, weight and activity level. Your surgeon will discuss the best option for you prior to surgery.
Depending on the type of shoulder joint damage you have, your doctor may recommend one of the following shoulder replacement options:
Total Shoulder Replacement
A total shoulder replacement (TSA) involves removing damaged areas of bone and replacing them with medical-grade implants designed to appear and function similar to a normal, healthy shoulder joint. The four soft tissue stabilizers of the shoulder (often referred to as the rotator cuff) must be functioning well to support the TSA procedure. For a TSA, both the damaged or diseased head of the humerus (also called the ball) and cartilage from the shoulder joint are replaced. Minimally invasive surgical methods are used when possible to help reduce the likelihood of damage to muscle and tissues, as well as help minimize post-operative pain.
Partial Shoulder Replacement
A partial shoulder replacement, or hemiarthroplasty, alleviates pain and restores function in patients whose damage is not extensive enough to require a total shoulder replacement. It involves only replacing the head (ball) of the joint. Partial shoulder replacement is ideal for patients who:
- Have isolated damage to the humeral head (rounded upper portion of the humerus bone), such as from a fracture or localized arthritis
- Maintain a stable and functional rotator cuff
- Are younger or moderately active, reducing the likelihood of implant wear
Reverse Total Shoulder Replacement
A reverse shoulder replacement is used in situations where a primary shoulder replacement cannot sufficiently address the patient’s shoulder injury. Instead of recreating the ball-and-socket joint in which the top of the arm bone (humerus) serves as the ball that fits into the socket of the shoulder, the socket is created at the top of the humerus and the artificial ball is anchored into what had been the shoulder socket.
Reverse total shoulder replacement is usually recommended for patients who have more complex shoulder issues, including massive rotator cuff tears or chronic shoulder dislocation.
After Surgery
After surgery, many patients can go home the same day. In some cases, patients may have to stay overnight and go home the following day.
Physical therapy for most patients will begin immediately following surgery to promote healing and stimulate circulation. As physical therapy progresses, treatment programs are tailored to heal and strengthen the body while aiming to reduce pain over time. Physical therapy exercises may include:
- Range of motion exercises
- Strengthening exercises
- Functional training exercises to improve shoulder function for daily activities
Patients must also perform appropriate rehabilitation at home to improve the long-term success of the joint replacement. These procedures might include physical therapy and taking medication in addition to any other measures prescribed by your surgeon.
Recovery varies for each patient. Many times, patients can return to work and light activity after 6-12 weeks, with full recovery within 6-12 months. The lifespan of the artificial implant is dependent on many factors, including age, weight and activity level, but is typically 15 or more years.
Important Information About Shoulder Replacement
Joint replacement surgery is not appropriate for patients with certain types of infections, any mental or neuromuscular disorder which would create an unacceptable risk of prosthesis instability, prosthesis fixation failure or complications in postoperative care, compromised bone stock, skeletal immaturity, severe instability of the joint, or excessive body weight.
Like any surgery, joint replacement surgery has serious risks which include, but are not limited to, pain, bone fracture, joint stiffness, amputation, peripheral neuropathies (nerve damage), circulatory compromise (including deep vein thrombosis (blood clots in the legs), genitourinary disorders (including kidney failure), gastrointestinal disorders (including paralytic ileus (loss of intestinal digestive movement), vascular disorders (including thrombus [blood clots], blood loss, or changes in blood pressure or heart rhythm), bronchopulmonary disorders (including emboli, stroke or pneumonia), heart attack, and death.
Implant related risks which may lead to a revision of the implant include dislocation, loosening, fracture, nerve damage, heterotopic bone formation (abnormal bone growth in tissue), implant wear-and-tear, metal sensitivity, soft tissue imbalance, osteolysis (localized progressive bone loss), audible sounds during motion, and reaction to particle debris.
The information presented is for educational purposes only. Speak to your doctor to decide if joint replacement surgery is appropriate for you. Individual results vary and not all patients will return to the same activity level. The lifetime of any joint replacement is limited and depends on several factors like patient weight and activity level. Your doctor will counsel you about strategies to potentially prolong the lifetime of the device. It is important to closely follow your physician’s instructions regarding post-surgery activity, treatment and follow-up care.
We understand that considering joint replacement surgery is a big decision. Our surgeons will diagnose your condition and work with you to discuss all options so you can make the most well-informed decision for your needs.