Shoulder replacement is primarily indicated for shoulder pain that has not responded to non-operative treatment, including physical therapy and medication. Specific indications include:
- Osteoarthritis (Degenerative Joint Disease)
- Rheumatoid Arthritis
- Post-traumatic Arthritis
- Rotator Cuff Tear Arthropathy
- Avascular Necrosis (Osteonecrosis)
- Severe Fractures
- Failed Previous Shoulder Replacement Surgery
In a shoulder replacement, damaged portions of the humerus (upper arm bone) and scapula (shoulder blade) are removed and replaced with artificial components in order to reduce pain and increase mobility. The shoulder is a "ball and socket" joint, and depending on the indication for a shoulder replacement, both components of the joint do not always need to be replaced. Your surgeon will evaluate your situation carefully before deciding which type of replacement is best for you. Types of shoulder replacement include:
Total Shoulder Replacement: This technique involves replacing the head of the humerus with a metal ball attached to a stem and replacing the "socket" portion of the scapula called the glenoid with plastic. The best candidates for this technique are those with bone-on-bone osteoarthritis and an intact rotator cuff.
Stemmed Hemiarthroplasty: Sometimes patients may only need the humeral head, or the "ball," replaced. When the head of the humerus is replaced with both a metal ball and stem, it is called a stemmed hemiarthroplasty. This procedure might be recommended in patients following shoulder trauma or arthritis involving only the humeral head but who have a normal socket, patients with severely weakened bone in the socket, or patients with severely torn rotator cuff tendons and arthritis.
Resurfacing Hemiarthroplasty: As an alternative to stemmed hemiarthroplasty, some patients may be candidates for replacing only the humeral head joint-surface without a stem, which is called a resurfacing hemiarthroplasty. Patients who are good candidates include those who have an intact cartilage surface on the glenoid (socket) and who do not have recent trauma to the humeral head or neck. This technique preserves humeral bone and decreases the potential risks of component wear and loosening related to total shoulder replacements.
Reverse Total Shoulder Replacement: In a reverse total shoulder replacement, the ball and socket are switched so that the metal "ball" is attached to the scapula (where the socket would normally be placed), and the plastic "socket" is attached to the upper arm (where the ball would normally be placed). This reversal allows the patient to use the deltoid muscle rather than the rotator cuff to elevate the arm. For this reason, this procedure is recommended for patients with completely torn rotator cuffs, rotator cuff tear arthropathy or a previous failed shoulder replacement.
Alternatives to Shoulder Replacement: With limited areas of cartilage damage in patients who primarily complain of motion loss, a minimally invasive arthroscopic procedure can be performed to release the tight capsule that surrounds the shoulder joint to improve range of motion and minimize pain. In some instances, depending on the extent of arthritis in the shoulder, a cartilage transplant can be performed. Most commonly, this is indicated in relatively young patients who have limited arthritis or cartilage loss on the humeral head (the ball) that can be replaced by fresh donor cartilage that is size and location matched to replace the damaged cartilage. This is called an osteochondral allograft. Similarly, there are transplant procedures that can be used to treat bone and cartilage loss of the glenoid (socket) that is most commonly associated with recurrent instability.
These procedures can be performed either as an out-patient or following a single-night stay in the hospital. It typically takes about 90 minutes to perform and generally does not require a patient to donate or receive blood. Following the procedure, you will be asked to wear a sling to minimize stress on the joint and facilitate healing. Pain medications will be prescribed to keep you comfortable. A post-operative rehabilitation program including range of motion and strengthening exercises will be advised beginning from the first post-operative day with a formal program starting about ten days after surgery. As with any surgical procedure, there may be certain risks and complications involved, including infection of the surgical wound, post-operative stiffness, problems with the prosthesis and injury to the nerves and blood vessels.
To learn more about these procedures, the Academic Resource Library contains a number of articles, videos and presentations published by Dr. Cole and his research team.