Surface replacement for shoulder arthritis: Surgery with a CAP, a special type of conservative resurfacing joint replacement that resurfaces the ball of the ball and socket joint, can lessen pain and improve function.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, January 09, 2008
Considering surgeryTypes of surgery recommended Several types of surgery can be helpful in the management of shoulder arthritis (arthritis of the glenohumeral joint). The surgical procedures can range from a replacement of the humeral head with a resurfacing CAP prosthesis [Figures 1 and 2], a humeral hemiarthroplasty with a non-prosthetic glenoid arthroplasty, a total shoulder arthroplasty. If the rotator cuff is deficient, a rotator cuff tear arthropathy (CTA) prosthesis may be considered. Finally, if the shoulder is unstable a reversed prosthesis, such as the Delta may be needed.Who should consider shoulder replacement surgery with a cap resurfacing prosthesis? Individuals with shoulder arthritis should consider shoulder joint replacement arthroplasty with a resurfacing (CAP) prosthesis if - the shoulder arthritis is a major problem for the individual,
- the individual is sufficiently healthy to undergo the procedure,
- the individual understands and accepts the risks and alternatives,
- there is sufficient bone to permit the surgery,
- the surgeon is experienced in shoulder replacement surgery, and
- the features of the arthritis and the shoulder favor a resurfacing prosthesis rather than a prosthesis with a stem that passes down the shaft of the bone.
Shoulder replacement surgery with a resurfacing (CAP) prosthesis is most effective when the individual follows a simple exercise program after surgery and understand the limitations of the procedure. Thus, the individual ‘s motivation and cooperation are important elements of the partnership.What happens without surgery? The rate of progression of shoulder arthritis is usually slow, thus surgery is not urgent. Surgical options Several types of surgery can be helpful in the management of shoulder arthritis (arthritis of the glenohumeral joint). The surgical procedures can range from a replacement of the humeral head with a resurfacing CAP prosthesis [Figures 1 and 2], a humeral hemiarthroplasty with a non-prosthetic glenoid arthroplasty, a total shoulder arthroplasty. If the rotator cuff is deficient, a rotator cuff tear arthropathy (CTA) prosthesis may be considered. Finally, if the shoulder is unstable a reversed prosthesis, such as the Delta may be needed.Effectiveness In the hands of an experienced surgeon, shoulder arthroplasty with a resurfacing (CAP) prosthesis can be helpful in restoring stability, comfort and function to the shoulder of a well-motivated individual with shoulder arthritis. The greatest benefits are often the ability to sleep on the affected shoulder and the ability to perform activities of daily living. As long as the shoulder is cared for properly and subsequent injuries are avoided, the benefit can last for years. Urgency In that shoulder arthritis progresses slowly, consideration of surgery is not urgent. Before surgery is undertaken, the individual needs to be in optimal health, understand and accept the risks and alternatives of surgery, and understand the postoperative rehabilitation program. Risks Shoulder replacement surgery for shoulder arthritis using a resurfacing (CAP) prosthesis carries significant risks that are important for the individual to consider. The risks of this surgery include but are not limited to the following: infection (which can be sufficiently serious to require revision surgery, including removal of the prosthesis), injury to nerves and blood vessels, fracture, stiffness or instability of the joint, dislocation, loosening of the prosthesis, pain, failure of tendon or muscle attachment, and the need for additional surgeries – any or all of which may result in major loss of function to the arm. There are also risks of anesthesia and blood transfusion (although transfusions are not usually necessary). An experienced shoulder joint replacement team will use special techniques to minimize these risks, but cannot totally eliminate them. Managing risk Some of the risks of shoulder replacement surgery with a resurfacing (CAP) prosthesis can be effectively managed if they are promptly identified and treated. Infections may require a wash out in the operating room—sometimes complete removal of the prosthesis 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 of the prosthesis may require surgical revision. If the individual has questions or concerns about the course after surgery, the surgeon should be informed as soon as possible. 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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