Total shoulder replacement surgery replaces the damaged bone and cartilage with a metal and plastic implant to help alleviate pain. The shoulder joint is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula). This joint allows people a wide range of motion at the shoulder.
Total shoulder replacement surgery involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem and a plastic socket. During the surgery, the ball is removed from the top of the humerus and replaced with a metal implant. The socket portion of the joint is shaved clean and replaced with a plastic socket.
The components come in various sizes. If the bone is of good quality, your surgeon may choose to use a non-cemented or a press-fit humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid component is implanted with bone cement.
Depending on the condition of the shoulder, your surgeon may replace only the ball. Sometimes, this decision is made in the operating room at the time of the surgery. Some surgeons replace the ball when it is severely damaged and the socket is normal.
At The Christ Hospital we have developed an advanced strategy for pain control that includes the use of a “pain cocktail” and a peripheral nerve block. We have found this approach to be very beneficial, as it markedly reduces or eliminates your need for intravenous or oral narcotics to control pain after your joint replacement. By reducing your pain and the use of narcotics after surgery, we are able to reduce your length of stay and improve the overall quality of your recovery.
Hospital stays vary from one to two days for most patients. You will be sent home wearing a sling and you should not attempt to use the arm except as specifically instructed by your doctor.
Arthritis is the most common reason people have shoulder replacement surgery. It affects mainly older individuals. Over time, the shoulder joint slowly becomes stiff and painful. Unfortunately there is no way to prevent the development of osteoarthritis. Patients with bone-on-bone arthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
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, it may be very difficult for a doctor to put the pieces back together. When the head of the upper arm bone is shattered, the blood supply to the bone pieces is interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for a severe shoulder fracture.
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 specific type of shoulder replacement, called a reverse total shoulder arthroplasty, may be necessary in this particular situation.
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. As the arthritis progresses, the pain may occur even when you rest. By the time a patient sees a physician for the shoulder pain, he or she often has pain at night. This pain may be severe enough to prevent a good night's sleep. The patient's shoulder may make grinding or grating noises when moved. Also, the shoulder may catch, grab, clunk or lock up. Over time, the patient may notice 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. Common symptoms of shoulder arthritis include:
- Pain with activities
- Limited range of motion
- Stiffness of the shoulder
- Swelling of the joint
- Tenderness around the joint
- A feeling of grinding or catching within the joint.