Total shoulder replacement (also called total shoulder arthroplasty) is a surgical solution for shoulder pain that involves replacing arthritic joint surfaces and damaged bone with artificial devices. About 53,000 people in the U.S. have shoulder replacement surgery each year.
The Midwest Orthopaedics at Rush (MOR) shoulder team at Rush University Medical Center performs more shoulder replacement surgeries than any other practice in Illinois. They also do one of the highest volumes of any practice in the United States. Each case is individual, but surgeon and supporting medical team experience is critical.
Many of the shoulder surgeons at MOR have helped design and develop shoulder implants that are used every year.
The shoulder is remarkable because of its incredible range of motion. That range stems from the way it is constructed. The shoulder is comprised of the collarbone (clavicle), the shoulder blade (scapula) and the upper arm bone (humerus). These three bones come together to form the shoulder joint. The wide-ranging motion afforded the shoulder comes from the ball and socket joint that is formed by the upper arm bone (humeral head or ball) that fits neatly into the socket of the scapula bone, called the glenoid.
Cartilage allows bones to move smoothly on each other without pain. When this ball-and-socket joint degenerates, often due to arthritis or shoulder fracture, these smooth surfaces become rough and bones rub against each other causing pain.
If conservative treatments such as medication, physical therapy and lifestyle modifications fail to alleviate pain, your doctor may recommend surgery as the best way to reduce pain and restore range of motion.
Surgical and technological advances allow skilled surgeons to replace the entire shoulder with one of two types of shoulder replacement procedures: total shoulder replacement and reverse total shoulder replacement.
Who is a candidate for total shoulder replacement?
MOR shoulder surgeons will be the most knowledgeable about your specific health issues and will be best equipped to advise you on whether you are a strong candidate for total shoulder replacement surgery. Typically, the following may be good candidates:
- Patients with long-term shoulder pain
- Those whose pain and stiffness persists with everyday activities
- Patients whose shoulder pain and stiffness interfere with sleep
- Those suffering severe degenerative arthritis, otherwise known as "wear and tear" arthritis of the shoulder (osteoarthritis)
- Those with severe fracture or severely damaged tissues involving the shoulder joint
- Patients suffering avascular necrosis, which is the loss of blood supply to the upper end of the arm bone (humerus)
- Those who have former shoulder surgery failure
- Patients with a tumor in or around the shoulder
- Those suffering loss of motion or who are experiencing weakness in the shoulder
- Patients with rheumatoid arthritis where inflammation has destroyed the shoulder cartilage
- A functioning rotator cuff is also important for total shoulder replacement surgery. However, there is a new procedure, called reverse shoulder replacement surgery, for patients who don't have functioning rotator cuffs. Physicians at Midwest Orthopaedics at Rush were involved in the clinical trials for and among the first in the country to begin offering reverse shoulder replacement surgery
What to expect from total shoulder replacement surgery
The main goal of total shoulder replacement surgery is to remove damaged material and replace it with an artificial (manmade) joint called a prosthesis to relieve shoulder pain. Many patients, however, also see marked improvement in motion, strength and function.
Prior to surgery, you will be given general or regional anesthesia so you won't feel the procedure. The surgeon will make an incision in the front of your shoulder to expose the damaged joint. Next, the damaged arthritic head (ball) of the humerus bone is removed and the remaining bone is prepared to accept the artificial implant. This portion of the prosthesis is made of very strong alloy metal and has a stem that fits inside the remaining arm bone. The stem may be cemented into place to provide additional stability if the upper arm bone is soft. If bone quality if good, a press-fit component may suffice.
Next, the glenoid (or socket) of the scapula is also prepared by removing the cartilage and machining the bone surface. Once prepared, a special plastic lining or "cup" is inserted and secured with cement. Not all patients require this artificial glenoid piece, however, most patients with osteoarthritis and rheumatoid arthritis do benefit from it.
Once both artificial components are in place, the shoulder is reduced so the humerus fits neatly into the glenoid (socket) and the incision is closed.
Depending on the quality of your glenoid (socket), you may only need to replace the humeral head (ball) of the upper arm bone. This procedure is called hemiarthroplasty and only a metal ball and stem is inserted.
Hemiarthroplasty is most effective for:
- Those who have arthritis in the humeral head and have a healthy glenoid
- Patients whose shoulders have weak glenoid bones
- Those patients with severely torn rotator cuff tendons and arthritis
Typically, osteoarthritis patients get better pain relief with total shoulder replacement than with hemiarthroplasty, but MOR shoulder physicians will advise you on the best treatment for your specific condition.