Total shoulder joint replacement for shoulder arthritis: Surgery with a dependable, time-tested conservative prosthesis and accelerated rehabilitation can lessen pain and improve function in shoulders with arthritis.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, May 14, 2008
Figure 6 - Humeral Implant Figure 7 - Glenoid bone being reshaped with a spherical reamer. Figure 8 - Humeral Cut: the amount of the damaged ball that is removed Considering surgeryTypes of surgery recommended Joint replacement surgery is the most effective method for restoring
comfort and function to shoulders damaged by severe arthritis.
When the normally smooth surfaces of the shoulder joint are severely
damaged by arthritis, injury or surgery, shoulder joint replacement
arthroplasty may be the most effective method for restoring comfort and
function to the joint. Other surgical options, such as arthroscopy or
"clean up" operations have not been shown to give lasting benefit.
Shoulder fusion can stabilize the joint, but does not allow motion at
the shoulder joint. Removing the joint allows some motion at the joint,
but does not provide stability.
Who should consider shoulder replacement surgery? Joint replacement surgery is considered when:
- the arthritis is a major problem for the patient,
- the patient is sufficiently healthy to undergo the procedure,
- the patient understands and accepts the risks and alternatives,
- there is sufficient bone and tendon to permit the surgery, and
- the surgeon is experienced in shoulder replacement surgery.
Total shoulder replacement is most effective when the patient
follows a simple exercise program after surgery. Thus, the patient's
motivation and dedication are important elements of the partnership. What happens without surgery? In general, this surgery is elective, and can be performed whenever
conditions are optimal. Sometimes the pain and stiffness from shoulder
arthritis will stabilize at a level that is acceptable to the patient.
In such cases the patient can delay surgery without compromising the
potential for future surgery. However, in cases of rheumatoid
arthritis, excessive delay may result in loss of the tendon and bone,
making the surgery more difficult for the patient and for the surgeon.
Surgical options Several types of shoulder arthroplasty are used to manage arthritis. In
total shoulder arthroplasty, the surfaces of both the humeral head
(ball) and the glenoid (socket) are resurfaced with metal and plastic
implants. Figure 6 shows the metal humeral ball and humeral stem as
well as the plastic glenoid prosthesis. In shoulder hemiarthroplasty,
only the humeral head surface is replaced. In shoulder hemiarthroplasty
with non-prosthetic glenoid arthroplasty, the humeral surface is
replaced and the glenoid socket is reshaped, but Figure 7 shows the
glenoid bone being reshaped with a spherical reamer. Figure 8 shows the
amount of the damaged ball that is removed (humeral cut).Effectiveness In the hands of an experienced surgeon, shoulder arthroplasty can be
very effective in restoring comfort and function to the shoulder of a
well-motivated patient. The greatest benefits are often the ability to
sleep on the affected shoulder and the ability to perform usual
activities of daily living. As long as the shoulder is cared for
properly and subsequent injuries are avoided, the benefit can last for
decades.Urgency Shoulder arthroplasty for arthritis is an elective procedure that can
be scheduled when circumstances are optimal. It is not an urgent
procedure. The patient has plenty of time to become informed and to
select and experienced surgeon.Risks The risks of total shoulder surgery include but are not limited to the
following: 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, and the need for
additional surgeries. There are also risks to anesthesia and blood
transfusion (although transfusions are not always necessary). An
experienced shoulder joint replacement team will use special techniques
to minimize these risks, but cannot totally eliminate them.Managing risk Many of the risks of shoulder arthroplasty surgery can be
effectively managed if they are promptly identified and treated.
Infections may require a "wash out" in the operating room--occasionally
removal of the artificial components is necessary. Blood vessel or
nerve injury may require repair. Fracture may require surgical
fixation. Stiffness or instability may require exercises or additional
surgery. Loosening or wear of the components may require surgical
revision. If the patient has questions or concerns about the course
after surgery, the surgeon should be informed as soon as possible.
Total shoulder joint replacement for shoulder arthritis
Surgery for shoulder arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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