Shoulder Arthroplasty (Replacement)

Shoulder arthroplasty (shoulder replacement) is an increasingly prevalent surgery undergone by thousands of Americans every year. It involves replacing some or all of the shoulder joint with prosthetic components and has overwhelmingly positive outcomes that can last for a decade or more.

While shoulder replacement surgery is rarely the first treatment option for shoulder issues, it may be indicated in cases where more conservative treatment options have been ineffective, pain is ongoing and severe, or you no longer have a functioning rotator cuff.

If you are experiencing shoulder pain that is impacting your daily activities and quality of life, shoulder arthroplasty could be the right treatment. Below, we’ll take a closer look at this procedure:

Understanding Shoulder Arthroplasty (Replacement)

Definition and Importance

Shoulder arthroplasty, commonly known as shoulder replacement surgery, replaces damaged portions of the shoulder joint with artificial components (prostheses). The surgery can offer life-changing pain relief and the opportunity to regain strength and range of motion in the shoulder and arm. Following shoulder arthroplasty, many patients are able to return to activities they were previously unable to do.

Historical Development

The first shoulder replacement was performed in Paris in 1893 but the procedure didn’t make its way to the U.S. until the 1950s, when it began to be used for the treatment of severe shoulder fractures. Today, the Agency for Healthcare Research and Quality reports that approximately 53,000 Americans undergo shoulder arthroplasty every year. It is now used to treat a wide variety of conditions that cause significant shoulder dysfunction.

Anatomy of the Shoulder Joint

The shoulder holds the distinction of being the most flexible joint in the human body. Composed of 3 bones, close to a dozen muscles, and many more tendons and ligaments, it is also one of the most complex.

Like the hip joint, the shoulder joint is a large ball and socket joint. The head of the humerus (upper arm bone) fits into a shallow socket in the scapula (shoulder blade) known as the glenoid, while the clavicle (collarbone) attaches the shoulder to the rib cage and holds it away from the body. Surrounding tendons and muscles, including the 4 muscles of the rotator cuff and their accompanying tendons, provide stability and support.

In a healthy shoulder joint, the many components work together to provide strength, stability, and range of motion. Cartilage and the synovial membrane (a thin, smooth tissue that covers and lubricates the joint) allow the shoulder bones to glide painlessly and with little to no friction.

Indications for Shoulder Arthroplasty

Shoulder arthroplasty may be indicated in cases where shoulder pain is severe, prolonged, and impacting quality of life. It may be the appropriate treatment option if:

• Shoulder pain is limiting the function of daily activities like driving, reaching into a cupboard, or sleeping.
• Shoulder pain is severe and/or accompanied by weakness, stiffness, loss of range of motion, and/or a grinding or grating sensation.
• Conservative treatment options, such as rest, physical therapy, and cortisone injections, have been unsuccessful.
• Previous shoulder surgeries have been unsuccessful.
• There is a severe shoulder fracture.
• Irreparable, and massive rotator cuff tear

Osteoarthritis and Rotator Cuff Tear Arthropathy

Osteoarthritis is arthritis (joint inflammation and tenderness) resulting from physical wear and tear or overuse of the shoulder joint and characterized by the breakdown of cartilage. It is most common in elderly patients but can also occur in young athletes such as tennis or golf players.

Rotator cuff arthropathy refers to degenerative arthritis of the shoulder joint that results from damage to the rotator cuff.

Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory autoimmune condition that causes the breakdown of smooth cartilage and increases friction in joints, causing pain and damage. It is one of the most common reasons why patients seek shoulder arthroscopy.

Types of Shoulder Arthroplasty

Shoulder arthroplasty can be performed as a complete or partial procedure (both components or one component of the joint replaced). The most common types of shoulder arthroplasty are:

Total Shoulder Arthroplasty

In a total shoulder arthroplasty (also known as anatomical shoulder replacement surgery), the glenoid socket is replaced with a plastic cup, and the humeral head is replaced with a smooth metal ball, sometimes attached to a longer stem.

Reverse Shoulder Arthroplasty

In a reverse shoulder arthroplasty procedure, the ball and socket are reversed. This surgery can offer improved stability outcomes when tendons have been damaged by severe arthritis or other causes. This allows the deltoid muscle to take over and power your shoulder to allow overhead function.

Procedure of Shoulder Arthroplasty

The decision to perform shoulder arthroplasty is based on patient history, physical examination, and the results of imaging tests such as an X-ray, CT, and sometimes MRI. The surgery involves opening the shoulder by making an incision in front of your shoulder, removing the arthritic sections of the joint, and replacing them with the metal/plastic implants.

Post-Operative Rehabilitation

Most patients can return to desk work within 2-3 weeks after shoulder replacement, while more physical jobs may require approximately 4 months of recovery or more. For most patients, unrestricted active use of the shoulder joint begins about 8 weeks after surgery. While most patients can return to physical labor jobs by 4-5 months, people will notice continued improvements up to about a year after surgery. Speak directly with your surgeon for a projected recovery timeline based on your personal needs and circumstances.

Physical Therapy

Successful recovery after shoulder arthroplasty is highly dependent on consistent physical therapy to improve strength, stability, and range of motion. This is something that your doctor will help monitor for continued signs of improvement throughout your post-operative recovery.

Long-Term Management

The vast majority of patients who undergo shoulder arthroplasty experience the reduction or elimination of pain and are able to return to activities they could not previously engage in.

Risks and Complications

Complications of shoulder arthroplasty, while not common, can include:

• Infection
• Instability and other prosthesis issues
• Nerve injury
• Tightness or stiffness (usually treatable with physical therapy)

Speak with your surgeon for more information about our award-winning team’s commitment to effectively reducing and mitigating surgical risks and complications.

Ready to learn more about shoulder arthroplasty? Contact us at Modern Orthopaedics of New Jersey today!