Evaluating a Shoulder Joint Replacement surgery

Joint Replacement Surgery has become a standard operative treatment for severe arthritis unresponsive to non-operative treatment. Although it is less common than knee or hip replacement, it is just as successful in relieving joint pain.

What are the causes of shoulder arthritis?

Several conditions can cause shoulder arthritis leading to severe shoulder replacement surgery.

1. Osteoarthritis (or Degenerative Joint Disease): Age relative ‘wear and tear’ type of arthritis.
2. Rheumatoid Arthritis
3. Post-traumatic Arthritis: Caused by a serious shoulder injury
4. Rotator Cuff-Tear Arthropathy: Patients with very large and long-standing rotator cuff tear may develop cuff tear arthropathy
5. Avascular Necrosis (Osteonecrosis): A painful condition that occurs when the blood supply to the bone is disrupted.
6. Severe Fractures
7. Failed previous Shoulder Replacement Surgery

When should one opt for Shoulder Joint Replacement?

The decision to undergo Shoulder Replacement surgery should be a cooperative one between you, your family and your orthopedic surgeon.

Patients who may benefit from this surgery often have:

• Severe pain that interferes with daily activities such as dressing, going to the loo, washing, etc.
• Resting pain that may hamper a good night’s sleep
• Loss of motion and/or weakness in the shoulder
• Failure to improve with other treatment such as medication, cortisone injection or physical therapy

What are the Shoulder Replacement options available?

Shoulder replacement surgery is highly technical. It should be performed by a surgical team with a high experience in this procedure.

There are different types of Shoulder Replacement surgeries:

1. Total Shoulder Replacement

• It involves replacing the arthritic joint surface with a highly polished metal ball attached to a stem and a plastic socket.
• They may be either cemented or “press fit” into the bone.
• Patient with bone-on-bone osteoarthritis and intact rotator cuff tenders are generally good candidates for conventional Total Shoulder Replacement.

2. Hemiarthroplasty

• Only the ball of the shoulder is replaced
• Indication for a Hemiarthroplasty include:

1. Severe fracture of the humeral head with normal glenoid (socket)
2. Arthritis that only involves the head of the humerus

3. Reverse Total Shoulder Replacement

In this, the socket and metal ball are switched, i.e., a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the rotator cuff to lift the arm. It is done for people who have:

• Completely torn rotator cuff with severe arm weakness
• The effect of severe arthritis and rotator cuff tearing (or cuff tear Arthropathy)
• Had a previous shoulder replacement that failed

What is the rehabilitation procedure?

A careful and well-planned rehabilitation program is critical to the success of a shoulder replacement. It usually starts with gentle physical therapy soon after the operation. The surgeon or physical therapist will provide a home exercise program to strengthen the shoulder and improve flexibility. Driving a car is not allowed for 2 to 4 weeks after surgery.

Thousands of patients have experienced an improved quality of life after Shoulder Joint Replacement surgery. They experience less pain, improved motion and strength, and better function.

The writer is Dr. Rajesh Singh – Joint Replacement Surgeon at Narayana Health, Jamshedpur.