“All you need to know about Shoulder Replacement Surgery”
— Get Well in India
Total Shoulder Replacement Surgery, also called as Total Shoulder Arthroplasty is a surgical procedure to replace the damaged ball and socket joint of the shoulder with an artificial one. The artificial joint is called a Prosthesis.
Total shoulder replacement surgery is not as common surgical procedure as knee replacement or hip replacement surgeries, but definitely as successful as them. It relieves the joint pain and restore active movements and quality of life.
The main aim of shoulder replacement surgery is pain relief, restoring motion, regaining strength and normal functioning of joints to perform day to day activities. Many patients after their surgery are able to take up their favourite sports again like tennis, golf and swimming, and many of them even start with their personal health regime such as gym, yoga, running or cycling.
Shoulder is the most movable joint in the human body. There is a very wonderful saying, ‘With great work, comes great responsibility’. This is absolutely true for the functioning of shoulder joint. Our shoulders help us with lifting heavier objects and so, stability is the most essential ingredient in the successful motion of a shoulder joint.
Certain work or even sports can put great pressure on shoulders due to which an injury might occur. Arthritis of the shoulder is one such condition where the cartilage deteriorates leading to wearing out of the joint surfaces exposing areas of raw bone. The joint surfaces eventually become rough and joint motion causes friction and abrasion. The capsule surrounding the shoulder joint may also become inflamed and contracted which results in pain, stiffness and loss of normal function.
An early treatment can save you from getting a shoulder replacement by taking anti-inflammatory medications, physiotherapy, proper resting and a reduction of stress bearing activities. However, as time goes by the pain and stiffness eventually become unbearable and then shoulder replacement surgery will be the best option left for you.
Dr. Shreedhar Archik
Shoulder Replacement Surgeon
Dr. Kaushal Malhan
Shoulder Replacement Surgeon
The shoulder is a ‘ball-and-socket’ joint, that enables us to raise, twist, bend and move our arms forward, sideways and behind. The shoulder is composed of three bones:
- Humerus (or the upper arm bone)
- Clavicle (or the collarbone)
- Scapula (or the shoulder blade that moves on our back)
The humerus and the scapula are the main joints of the shoulder and together they form the ‘glenohumeral’ joint. The glenohumeral joint is like a ball-in-socket joint (like the hip). The top of the humerus is round like a ‘ball’. It rotates in a shallow basin, called the glenoid, on the scapula.
A group of ligaments, called the joint capsule, hold the ball of the humerus in position. Ligaments are strong tissues that provide stability. In other words, the joint capsule is responsible for holding our arm in place on our body.
Several ligaments connect our shoulder bones together. Tendons attach our muscles to our bones. Our muscles move our bones by pulling on our tendons. They move our arms to position our hands for a variety of functions. The shoulder also provides stability when our elbow flexes as we lift objects.
The Rotator Cuff tendons connect strong muscles to the humerus bone. These muscles allow the arm to rotate and move upward to the front, behind, and sideways. A fluid-filled sack, called the subacromial bursa, lubricates the rotator cuff tendons. It allows us to perform smooth and painless motions. Rotator cuff muscles are used to perform overhead motions, such as lifting up our arms to put on clothes, combing hair, or reaching for an item on a top of a cupboard shelf. These motions are used repeatedly during sports, such as pitching in baseball, serving a ball in tennis, and passing the football.
The most common cause of chronic shoulder pain is Arthritis like Osteoarthritis or Rheumatoid arthritis. Let us take a closer look at the potential causes:
- Osteoarthritis: It tends to develop as people age. Mostly it occurs in patients over the age of 50. It occurs from the overuse of joints causing our protective cartilage to wear away which causes stiffness and pain in the shoulder joint. Your orthopedic doctor may first recommend anti-inflammatory medication, but if does not result in reduction of pain or improved mobility, you may have to consider total shoulder replacement.
- Rheumatoid arthritis: This is one of the most serious and disabling arthritis. It can affect people of all ages, but most frequently occurs in women over the age of 30. It is a long-lasting autoimmune disease that causes the synovium to be inflamed and painful. It also causes joint swelling and deterioration. Tissues surrounding the joint may also become affected resulting in pain, stiffness and swelling.
- Fractures: In the case of a severe injury, the head (or ball) of the arm bone can be damaged so badly that it cannot be restored and therefore must be replaced and your surgeon may then recommend you a partial or total shoulder replacement to replace the broken bone, stabilize the joint and restore function.
- Rotator Cuff Tear: A rotator cuff tear happens when a patient sustains an injury to one of the muscles that wrap around the upper portion of the arm bone. These muscles are essential for providing stability in the shoulder joint and if that injury is left unaddressed, it can result in chronic arthritis.
- Avascular necrosis: This is also called Osteonecrosis. It is a painful condition that occurs when the blood supply to the bone is disrupted. This can cause destruction of the shoulder joint and lead to arthritis. Steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease and heavy alcohol use are risk factors for osteonecrosis.
If you have tried the non-operative treatments and you are still suffering from acute shoulder pain then watch for the signs mentioned below:
- Severe shoulder pain that interferes with everyday activities from bathing to simple household chores.
- Loss of motion and weakness of the shoulder.
- Shoulder pain that continues while resting.
- Stiffness in a shoulder that limits the ability to move or raise your arm or lift objects.
Your doctor can diagnose arthritis by conducting a physical examination. You will be asked about your symptoms and severity of pain. You may be asked to perform simple arm and shoulder movements to help your doctor assess your muscle strength, joint motion, and joint stability. Blood tests and other tests may identify what type of arthritis you have.
Your physician will ask for an X-ray to see the condition of your shoulder bones and to identify areas of arthritis or bone swelling. Your doctor might ask you for Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans to get a better view of the bone and soft tissue structures.
After reviewing your reports, you doctor might recommend a shoulder replacement surgery.
Surgical Procedure Details
There are different types of shoulder replacements. Your surgeon will evaluate your condition, your tests results and other factors carefully before concluding on which type of shoulder replacement surgery would be the best bet for you.
Total Shoulder Replacement: A total shoulder replacement may be recommended for patients suffering from severe osteoarthritis in the glenohumeral joint (The humerus and the scapula together form the ‘glenohumeral’ joint).
A total shoulder replacement is an open procedure which involves replacing shoulder joint with a prosthesis. The prosthesis consists of two components. The first is a humeral head component, which is a metal ball that is secured into the humerus bone with a stem. The second is a glenoid component, which replaces the glenoid and allows smooth movement of the new humeral head. This provides a close replication to the shoulder joint and relieves pain and discomfort by replacing the severely affected joint with a manmade joint. The wound is generally closed with absorbable sutures.
Reverse Total Shoulder Replacement: A reverse total shoulder replacement may be recommended to patients suffering from severe joint arthritis with irreparable rotator cuff tears or to patients with irreparable proximal humeral fracture.
The prosthesis used in a reverse total shoulder replacement is similar to what is used in a total shoulder replacement, however, the prosthesis is reversed, hence, it is called Reverse total shoulder replacement surgery. The metal ball portion of the prosthesis replaces the glenoid and the socket is attached to a stem that is placed into the humerus bone.
Post surgery, typically you will stay in the hospital for 2-3 days, but it entirely depends on your progress. You will be given medication to reduce your pain and to make you feel as comfortable as possible. To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.
Depending upon your range of motion and stability of the implant, you physiotherapy will begin on the first post-operative day, x-rays will be documented to find out that the implant is properly positioned.
You will be allowed to use the hand and wrist soon after surgery. Active use of the arm may begin as early as eight weeks after surgery. You will also be encouraged get up and out of the bed soon after surgery.
Avoid lifting weight, jerks, pushing and pulling for six weeks after surgery. Driving is recommended only after the shoulder has regained comfort and the necessary motion and strength. This may take several weeks after surgery. Thus, the patient needs to be prepared to have less arm function for the first month or so after surgery.
- 3 months after surgery: Most patients are reasonably comfortable in a period of three months. As compared to a normal shoulder, they can move their shoulder half of normal, but they experience some weakness and it takes time to strengthen that area.
- 6 months after surgery: Most patients are pain-free in a period of six months. As compared to a normal shoulder, they have motion and strength of about two-thirds of a normal shoulder.
- One year after surgery: About 95% of patients will be pain-free in a year, and the remaining 5% will usually have no more than a weather ache or an occasional ache with over activity.
- No pain: Your new joint should allow you to be more active. Providing painless movement of your arm and restoring mobility.
- No stiffness or impaired movements: This allows you to perform range of tasks including sport, swim, lifting heavier objects, driving and other activities over a period of time.
- Restore quality of life: Your ability to do your daily chores without pain will enhance the quality of your life.
- Best Technology available: Best available technology has led to the development of long lasting materials used in the surgery which lasts for many years.