Shoulder Replacement Surgery: An Effective & Proven Solution

Shoulder replacement surgery is increasingly recognized as an effective procedure for relieving shoulder pain in many complex cases, now achieving success rates comparable to those of hip and knee replacements. This surgery allows patients to resume everyday activities with reduced discomfort. Because of its challenging nature, most surgeons are not trained to do these surgeries by default. It is of vital importance therefore, that you choose a surgeon with the best training and experience to perform your Shoulder Replacement Surgery should you require one.

Long History of this Procedure

First performed in the 1950s in the United States to treat severe shoulder fractures, shoulder replacement surgery has since expanded to address various painful shoulder conditions, including different types of arthritis. According to a May 2021 article in the “Journal of Shoulder and Elbow Surgery” (JSES), more than 100,000 shoulder replacement procedures are performed annually in the U.S. This includes total shoulder replacements, hemiarthroplasties, and reverse total shoulder replacements. Projections suggest that by 2025, this number could increase to between 174,000 and 350,000 procedures annually. In India, the number of these surgeries is increasing at an exponential rate annually. this is attributed to the rise of better Healthcare being made available to the maximum number of people possible. The rise of self education among patients allows them to seek out the best possible solutions to their difficult problems.

If nonsurgical treatments such as medications and lifestyle modifications no longer alleviate your shoulder pain, shoulder joint replacement surgery may be a viable option. Whether you are just beginning to explore treatment options or have already decided on surgery, this article will provide you with a comprehensive understanding of the procedure.

Shoulder Anatomy

The shoulder consists of three bones:

- The humerus (upper arm bone)

- The scapula (shoulder blade)

- The clavicle (collarbone)

As a ball-and-socket joint, the shoulder allows for a wide range of motion. The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade, known as the glenoid. The joint surfaces are covered with articular cartilage, a smooth substance that protects the bones and enables easy movement. The synovial membrane, a thin, smooth tissue, covers the remaining surfaces inside the joint, producing fluid that lubricates the cartilage and eliminates almost all friction. Surrounding muscles and tendons provide stability and support, enabling the shoulder's extensive range of motion.

Shoulder Replacement Surgery Overview

Shoulder replacement surgery involves removing damaged parts of the shoulder and replacing them with artificial components, known as prostheses. The options include:

- Replacing only the head of the humerus (the ball)

- Replacing both the ball and the socket (glenoid)

Causes for Shoulder Replacement

Several conditions may lead to shoulder pain and disability, prompting consideration of shoulder replacement surgery:

- Osteoarthritis (Degenerative Joint Disease): An age-related wear-and-tear condition typically affecting individuals over 50, though it can occur in younger people. As the cartilage that cushions the shoulder bones deteriorates, bones rub against each other, leading to stiffness and pain.

- Rheumatoid Arthritis: A chronic inflammatory disorder where the synovial membrane becomes inflamed and thickened, eventually damaging cartilage and causing pain and stiffness.

- Post-traumatic Arthritis: This condition can develop following a significant shoulder injury, such as fractures or tears in the shoulder tendons or ligaments, leading to long-term joint damage.

- Rotator Cuff Tear Arthropathy: A condition that may develop in patients with long-standing, large rotator cuff tears, leading to joint destruction and arthritis.

- Avascular Necrosis (Osteonecrosis): This painful condition occurs when the blood supply to the bone is disrupted, causing bone cell death and potential joint destruction.

- Severe Shoulder Fractures: Severe fractures, particularly in older patients with osteoporosis, can make it difficult to repair the shoulder without a replacement.

- Failed Previous Shoulder Replacement Surgery: In some cases, previous shoulder replacements may fail due to implant loosening, wear, infection, or dislocation, necessitating revision surgery.

Is Shoulder Joint Replacement Right for You?

Deciding on shoulder replacement surgery should be a collaborative process involving you, your family, your family physician, and your orthopedic surgeon. Surgery is often recommended for individuals with:

- Severe shoulder pain that interferes with daily activities

- Moderate to severe pain at rest, which may disturb sleep

- Loss of shoulder motion and/or strength

- Inadequate relief from other treatments, such as anti-inflammatory medications, cortisone injections, or physical therapy

Choose the Best Shoulder Replacement Surgeon in Mumbai to evaluate if this surgery is the right Solution for You.

Orthopedic Evaluation

An orthopedic surgeon will perform a thorough evaluation to determine if shoulder replacement surgery is appropriate for you. This evaluation includes:

- Medical history: Gathering information about your general health and shoulder pain.

- Physical examination: Assessing shoulder motion, stability, and strength.

- X-rays: Evaluating the extent of damage to the shoulder joint.

- Other tests: Occasionally, blood tests, CT scans, or MRI scans may be ordered to assess the bones and soft tissues.

Based on the evaluation results, your shoulder surgeon will discuss whether shoulder joint replacement is the best option for relieving your pain and improving function, along with other potential treatment options.

Shoulder Replacement Options

Shoulder replacement surgery is a technically advanced procedure requiring an experienced surgical team. Several types of shoulder replacements exist, and your surgeon will carefully evaluate your specific situation to recommend the most suitable option.

- Total Shoulder Replacement: Replacing both the arthritic joint surfaces with a metal ball and a plastic socket.

- Hemiarthroplasty: Replacing only the humeral head with a metal ball.

- Resurfacing Hemiarthroplasty: Replacing just the joint surface of the humeral head with a cap-like prosthesis.

- Reverse Total Shoulder Replacement: A procedure where the ball and socket are reversed, allowing the deltoid muscle to compensate for a torn rotator cuff.

Potential Complications

As with any surgery, shoulder replacement carries risks, including:

- Infection: May occur in the wound or deep around the prosthesis.

- Prosthesis Problems: Wear, loosening, or dislocation of the prosthesis over time may require additional surgery.

- Nerve Damage: Although infrequent, nerve injuries can occur during surgery.

- Fractures: Stress fractures can develop around the implant.

Preparing for Surgery

Preparation for shoulder replacement surgery includes a complete medical evaluation, medication review, and home planning. It is essential to make necessary home adjustments to ease your recovery and ensure adequate support post-surgery.

Recovery

Recovery from shoulder replacement surgery typically involves a hospital stay of one to two days, followed by a structured rehabilitation program. Pain management is crucial during this period, with medications prescribed to alleviate discomfort. Physical therapy will begin soon after surgery to help restore strength and mobility.

Long-term Success

Adhering to your surgeon's postoperative instructions and engaging in the prescribed rehabilitation program are vital to the success of your surgery. Patients who follow these guidelines often experience significant improvements in pain, motion, and overall quality of life.

Dr Dharmarajan is a Fellowship trained Senior Orthopedic Surgeon with vast experience in these complex surgeries.