Introduction
The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.
When the cartilage is damaged, the two bones rub against each other resulting in pain, swelling, and stiffness of the joint (osteoarthritis).
Total shoulder replacement surgery is performed to relieve these symptoms. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.
Indications
Total shoulder joint replacement surgery is indicated for conditions such as arthritis when medication, injections, physical therapy, and activity changes do not help relieve pain. It may also be indicated if you have an irreparable rotator cuff. Your doctor recommends surgery when you have the following symptoms:
- Severe shoulder pain that restricts daily activities
- Moderate to severe pain during rest
- Weakness and/or loss of motion
Diagnosis
To decide whether total shoulder replacement is a good option for you Dr. Mathew will evaluate your condition thoroughly.
Dr. Mathew will review your medical history and perform a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI (magnetic resonance imaging) or CT SCAN are ordered. Depending on these imaging findings you may be indicated for a total shoulder or reverse total shoulder replacement. In most cases, Dr. Mathew will get a CT SCAN to help build an implant that is personalized for your shoulder.
Procedure
Note:This is only an animation for education. The exact implant type and surgery is different and personalized for each patient.
The surgery is done under general anesthesia. For most patients a block is done by the anesthesia team to provide improved pain control after surgery. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint.
The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head and glenoid are cut and prepared with artificial components.
After the artificial components are implanted, the joint capsule is stitched and the wound is closed.
Post-operative Care
After the surgery, medications are prescribed to control pain and muscle spasms. Your arm may be secured in a sling. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You may be able to perform gentle daily activities two to six weeks after surgery.
Risk and Complications
As with any major surgery, there may be potential risks involved:
- Anesthetic complications such as nausea, dizziness, and vomiting
- Infection of the wound
- Dislocation, requiring repeat surgery
- Damage to blood vessels, nerves, or muscles
- Failure to relieve pain
- Pulmonary embolism
- Wear and tear of prosthesis
Summary
Shoulder replacement surgery involves the replacement of the shoulder joint with artificial components to relieve pain and provide improved mobility of the shoulder joint when other conventional methods fail to provide relief. As with any surgery, shoulder replacement also has risks and complications. It is important you thoroughly discuss both its risks and benefits with your surgeon before undergoing the surgery.
