Shoulder Joint Replacement

Although shoulder replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. Shoulder replacement surgery started in the United States in the 1950s. It was used as a treatment for severe shoulder fractures. Over the years, this shoulder surgery has come to be used for many other painful conditions of the shoulder. These include:

• Osteoarthritis (degenerative joint disease)
• Rheumatoid arthritis
• Post-traumatic arthritis
• Rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
• Avascular necrosis (osteonecrosis)
• Failed previous shoulder replacement surgery
• Severe Fractures

Anatomy
The shoulder is a ball-and-socket joint in which the rounded end of the upper arm bone (head of the humerus) glides against the small dish-like socket (glenoid) in the shoulder blade (scapula). These joint surfaces are normally covered with smooth cartilage that allows the shoulder to rotate through a greater range of motion than any other joint in the body.

Cause
Osteoarthritis is a common reason people have shoulder replacement surgery. Osteoarthritis is sometimes called "wear-and-tear" arthritis as it can lead to loss of the cartilage and mechanical deterioration of the shoulder joint. It affects mainly older individuals in all walks of life. Over time, the shoulder joint slowly becomes stiff and painful, and it may grind or clunk. This can lead to a loss of strength, decreased range of motion in the shoulder and impaired function. Unfortunately there is no way to prevent the development of osteoarthritis, however, shoulder replacement is an excellent treatment option.

A severe fracture of the shoulder is another common reason people have shoulder replacements. When the shoulder is injured by a hard fall or car accident in a patient with osteoporosis, it may be very difficult to put the pieces back together and the blood supply to the bone pieces may become disrupted. Shoulder replacement is in these instances is a better alternative to fracture fixation. Patients with a massive long-standing rotator cuff tear may develop cuff tear arthropathy. In this injury, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage. A special kind of shoulder replacement called “reverse total shoulder replacement” is indicated in the case of rotator cuff arthropathy.

Avascular necrosis is another condition treated with shoulder replacement, in which the bone of the humeral head dies due to lack of blood supply. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease and heavy alcohol use are some of the risk factors for avascular necrosis.

Symptoms
Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. Eventually the pain may become severe enough to prevent a good night's sleep. The shoulder may make grinding or grating noises during movement. Alternatively, the shoulder may catch, grab, clunk or lock up. Over time, there may be a loss of motion and/or weakness in the affected shoulder. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite armpit may become increasingly difficult.

Conservative Treatment
Treatment of an arthritic shoulder starts with rest, exercise and taking arthritis medications. Resting the shoulder and applying moist heat can ease mild pain. After strenuous activity, an ice pack may be more effective at decreasing pain and swelling.
Physical therapy may also be helpful when arthritis is in early stages. It helps maintain joint motion and strengthen the shoulder muscles. Physical therapy is less effective when the arthritis has advanced to the point that bone rubs on bone. When this is the case, physical therapy may make the shoulder hurt more.
Arthritis medications, called nonsteroidal anti-inflammatories (NSAIDs), can control arthritis pain. Steroid injections into the shoulder joint can provide temporary pain relief. Excessive cortisone shots can have adverse effects, however.

Shoulder Joint Replacement (Shoulder Arthroplasty):
If conservative treatments fail, shoulder replacement surgery may be needed. There are several different types of shoulder replacements. Typically total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket. Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Depending on the condition of the shoulder, Dr. Samimi may replace only the ball (Hemiarthroplasty). Sometimes, this decision is made in the operating room at the time of the surgery. This is frequently performed for severe fractures when the socket is normal.

Another type of shoulder replacement is called reverse total shoulder replacement. This surgery was developed in Europe in the 1980s and was approved by the Food and Drug Administration (FDA) for use in the United States in 2004. Reverse total shoulder replacement is used for people who have an irreparable rotator cuff in combination with severe arthritis.

X-Rays before and after reverse total shoulder replacement for cuff tear arthropathy

Shoulder replacement surgery is highly technical.  It should be performed by a surgical team with experience in this procedure.  Each case is individual.  Dr. Samimi will evaluate your situation carefully before making any decisions.  

Rehabilitation
The surgery is performed on an inpatient basis.  Most patients are discharged from the hospital on the second or third day after the operation.

A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. You wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery.

For detailed information about this condition and treatments such as Shoulder Replacement please visit: AAOS Online Service Fact Sheet - Shoulder Joint Replacement

Dr. Samimi is a Los Angeles orthopedic surgeon offering shoulder replacement surgery at 3 location in West Covina, Encino and Brentwood / West LA.