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 Friday, August 01, 2008
About the procedureTechnical details Shoulder replacement surgery is a highly technical procedure; each step plays a critical role in the outcome.
After the anesthetic has been administered and the shoulder is
prepared, an incision is made across the front of the shoulder from the
middle of the collarbone to the middle of the arm bone as shown in
figure 9. This incision allows access to the joint without damaging the
important deltoid or pectoralis muscles that are responsible for a
significant portion of the shoulder's power.
The muscles and other tissues near the shoulder are mobilized by
removing any scar tissue that may restrict their motion. Figure 10
shows how the tendon of the subscapularis muscle is cut to gain access
to the joint and released circumferentially (a 360-degree release) to
restore its length and mobility. Figure 11 shows where the arthritic
humeral head (ball of the joint) is removed. The bone spurs are removed
to prepare the bone for the humeral prosthesis.
If the glenoid socket is unaffected or in other selected conditions,
a hemiarthroplasty may be performed (replacing the ball only). For
example in cuff tear arthropathy, a hemiarthroplasty (replacing the
humeral joint surface only) is usually selected because the anatomy
does not favor the use of a glenoid prosthesis. The humeral component
is made of metal and is usually press fit, but sometimes cemented, into
the shaft of the bone of the humerus.
If the glenoid is affected, but conditions do not favor the
insertion of a glenoid component, a non-prosthetic glenoid arthroplasty
may be performed along with a humeral hemiarthroplasty. In this
procedure, the glenoid shape and orientation are corrected, but a
glenoid prosthesis is not inserted. The reshaping of the socket using a
spherical reamer is shown in the figure. The prosthetic ball of the
humeral component articulates with the reshaped bony socket of the
glenoid. This procedure may be selected when the patient is interested
in performing heavy activities that might endanger the fixation of a
polyethylene glenoid component.
In a total shoulder joint replacement, the glenoid bone is shaped
and oriented as in the non-prosthetic glenoid arthroplasty and then
covered with a polyethylene glenoid component, as seen in the figure. A
small amount of bone cement is used to hold the artificial glenoid
socket in place.
At the conclusion of any of these procedures, the subscapularis
tendon is securely repaired to the bone. This repair requires
protection from active use for at least 6 weeks while it is healing. Anesthetic Shoulder joint replacement surgery may be performed under a general
anesthetic or under a brachial plexus nerve block. A brachial plexus
block can provide anesthesia for several hours after the surgery. The
patient may wish to discuss their preferences with the anesthesiologist
before surgery.Length of shoulder replacement surgery The procedure usually takes approximately two hours, however the
preoperative preparation and the postoperative recovery may add several
hours to this time. Patients often spend two hours in the recovery room
and two to four days in the hospital after surgery.
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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