Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
Edited By: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Tuesday, May 13, 2008
Figure 6 - Humeral implant Figure 7 - Humeral Cut: the amount of the damaged ball that is removed. Figure 8 - Glenoid bone being reshaped with a spherical reamer. Considering surgeryWhat kinds of surgery are recommended for arthritis of the shoulder? When the normally smooth surfaces of the shoulder joint are severely
damaged by arthritis or injury, shoulder replacement surgery is the
most effective method for restoring comfort and function to the joint.
There are other surgical options for treatment of arthritis of the
shoulder, but none have proven as effective in terms of pain relief and
patient satisfaction as shoulder replacement. Arthroscopy or "clean up"
operations have not been shown to give lasting benefit. Shoulder fusion
can stabilize the joint, but does not allow shoulder motion. Removing
the joint allows some motion at the joint, but does not provide
stability.Who should consider non-prosthetic glenoid arthroplasty for arthritis of the shoulder and in what cases? 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.
What happens if nothing is done for arthritis of the shoulder (best case/worst case scenarios)? The natural history of arthritis is that it usually continues to
progress over time. The rate of progression varies between individuals
and is unpredictable. Sometimes the pain and stiffness from shoulder
arthritis will stabilize at a level that is acceptable and manageable
to the patient. In general, this surgery is elective, and can be
performed whenever the patient decides that the arthritis has become
disabling enough to warrant treatment. Delaying surgery typically does
not compromise the success of surgery in the future. 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.
What options exist for surgery for arthritis of the shoulder? 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, a
prosthesis is used only on the humeral side of the joint. Because the
humeral component can usually be secured by a press fit, most humeral
replacement surgery does not require bone cement. As a result, the risk
of cement failure is eliminated. Figure 7 shows the amount of the
damaged ball that is removed (humeral cut). In shoulder
hemiarthroplasty with non-prosthetic glenoid arthroplasty, the humeral
surface is replaced and the glenoid socket is reshaped. Figure 8 shows
the glenoid bone being reshaped with a spherical reamer.
The decision about which type of shoulder replacement will maximize
benefit and minimize risk depends on several factors. These include the
location and severity of the arthritis, the age of the patient and the
level of physical demand the patient expects to exert on the replaced
shoulder. When advanced arthritis has destroyed both the ball and
socket, then both sides of the joint must be addressed.
As with joint replacement procedures in other parts of the body, the
plastic components used in the replacement do not last forever. Much
like the brakes of a car wear out with use, the plastic socket used in
total shoulder replacement surgery tends to wear with time. The process
can take the form of flattening, loosening or breaking. In each case,
the socket is no longer able to provide a smooth and stable foundation
for the ball. Patients will often note that their comfort and function
decline as the socket begins to fail. If the socket breaks, patients
often notice an immediate increase in pain with shoulder use.
It stands to reason that younger and more active patients are more
likely to experience socket wear in the course of their life as the
plastic is exposed to a longer period of use. In addition, patients who
remain physically active often place higher demands on the shoulder. As
more people continue to engage in sports and other demanding
recreational activities into their 60’s, 70’s and
80’s, shoulder replacements are being asked to tolerate more wear
and tear – often the same level of use that may have predisposed
the shoulder to develop arthritis in the first place.
Younger patients and those who intend to return to a high level of
physical activity are at risk of developing socket failure after total
shoulder arthroplasty. In certain cases, this can occur within the
first several years after surgery. When failure occurs, additional
surgery is usually required to remove the damaged socket. If the bone
underneath the socket has also been damaged by the wear and loosening
process, it may be impossible to replace the socket. In this case, the
success of revision surgery is less predictable.
When performed by an experienced surgeon, how effective is non-prosthetic glenoid arthroplasty for arthritis of the shoulder likely to be and how long will the benefit last? Non-prosthetic glenoid arthroplasty addresses the risk of socket
failure in younger and physically demanding patients. Because no
plastic is inserted into the joint, there are no problems related to
artificial socket wear, loosening and breaking. In the hands of
experienced surgeons, this procedure has proven durable in terms of
allowing patients to return to their expected level of activity. Some
patients who have undergone this procedure have returned to
weightlifting, water-skiing, golf and landscaping. As long as the
shoulder is cared for properly and subsequent injuries are avoided, the
benefit can last for decades.
Shoulder replacement surgery is most effective when the patients are
well motivated and follow a simple exercise program after surgery.
Thus, the patient's motivation and dedication are important elements of
the partnership. Especially after non-prosthetic glenoid arthroplasty,
the need for patience is essential during the early phase of the
rehabilitation while the shaped glenoid surface is healing. How urgent is non-prosthetic glenoid arthroplasty for arthritis of the shoulder? Shoulder hemiarthroplasty with non-prosthetic glenoid arthroplasty
is an elective procedure that can be scheduled when circumstances are
optimal for the patient. It is not an urgent procedure. The patient has
plenty of time to become informed and to select and experienced
surgeon.
Factors that the patient should consider in choosing the optimal time include the following:
- The arthritis has become sufficiently disabling to impair the
performance of daily activities. Patients who are still able to sleep
comfortably and manage daily activities may consider waiting.
- A planned period of time can be specifically dedicated to the
recovery and rehabilitation process that will not interfere with other
scheduled events.
- Overall health and nutritional status are optimal and will not
limit the ability to comply with the performance of rehabilitation.
- Motivation and readiness to undertake the process of surgery, recovery and rehabilitation is a priority.
What are the most frequent and most serious risks of non-prosthetic glenoid arthroplasty for arthritis of the shoulder? How common are they? The risks of shoulder hemiarthroplasty with non-prosthetic glenoid
arthroplasty include but are not limited to the following: infection,
injury to nerves and blood vessels, fracture, stiffness or instability
of the joint, 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).
Furthermore, it is possible that the joint will remain or become
painful without plastic resurfacing of the glenoid. In such a case, it
may be necessary to revise the hemiarthroplasty to a total shoulder
arthroplasty.
An experienced shoulder joint replacement team will use special
techniques to minimize these risks, but cannot totally eliminate them. If risks occur during or after non-prosthetic glenoid arthroplasty for arthritis of the shoulder how are they managed? Many of the risks of this 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. If the patient
has questions or concerns about the course after surgery, the surgeon
should be informed as soon as possible.
Surgery for Arthritis of the Shoulder 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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