Total Shoulder Replacement

The shoulder is a ball-and-socket joint wherein the head of the humerus is the ball and the glenoid is the socket. Arthritis may cause severe shoulder pain due to loss of the smooth cartilage in the shoulder. X-rays can show when the normally smooth cartilage of the shoulder joint has been destroyed by arthritis. In shoulder arthritis the joint surface is destroyed by wear and tear, inflammation, injury or previous surgery. This joint destruction makes the shoulder stiff, painful and unable to carry out its normal functions. Because there are many conditions that can lead to a painful joint, the shoulder surgeon must find out whether arthritis is the cause of the problem. The surgeon must also consider other possibilities such as rotator cuff disease, frozen shoulder, and shoulder pain from neck arthritis

If your shoulder surgeon determines that arthritis is the cause of the problem in your shoulder they should let you know if surgery is likely to be helpful.

The patients that are most likely to benefit from this type of surgery are those that are well motivated and in good health.
The surgery will replace the destroyed joint surfaces with an artificial joint. Shoulder replacement surgery provides a new metal ball for the humerus and a new plastic liner for the glenoid. Many times, the ball is much more severely worn than the socket. In these instances, the ball may be replaced and the socket left alone (also known as a "hemiarthroplasty", that is, a half a joint replacement).

The metal ball replacing the humeral head is anchored to the humerus by a stem that fits into the canal of the humerus. The stem is either held by cement (polymethylmethacrylate) or coated with a surface that allows the bone to grow into the stem. When the glenoid, or socket, is replaced, a plastic (ultra high molecular weight polyethylene) socket is cemented in place.

The surgery takes about 2 hours to complete. Therapy is started immediately after the procedure. Patients are usually in the hospital for 2-3 days after the surgery. Many patients notice a rapid relief of the arthritis pain after the surgery. The recovery of strength in the shoulder can take up to a year.

The shoulder joint replacement team will use special techniques to minimize the risks of total shoulder sugery, but the risks cannot be totally eliminated. The risks include but are not limited to:

infection
injury to nerves and blood vessels
fracture
stiffness or instability of the joint
loosening or wear of the artificial parts
failure of the rotator cuff
pain
the need for more surgeries
There are also risks linked with anesthesia and blood transfusion.

For those patients who's arthritis is not severe or who are not good candidates for major surgery, non-operative treatment may be recommended. Your doctor may suggest non-steroidal anti-inflammatory medications to lessen the discomfort of the arthritis. Patients need to be aware of the possible side effects of these medications, which include stomach irritation, kidney problems and bleeding.

Gentle stretching exercises may be helpful in maintaining the function of the shoulder.

A good result from total shoulder replacement depends on the patients following a simple exercise program after surgery. Thus, the patient's motivation and dedication are important parts of the partnership.