With three interconnected components in the collarbone (clavicle), upper arm (humerus), and shoulder blade (scapula), your shoulder joint uses a ball-and-socket function for movement, which is bolstered by protective cartilage, tissue, and various muscles and tendons. Multiple forms of arthritis can prompt severe shoulder pain that is symptomatic of decreased cartilage, rotator cuff tears or other conditions and that requires total shoulder joint replacement surgery if other treatment options have failed. This procedure is most commonly performed for older patients suffering from these issues and can be performed in several different ways.
Your provider will assess your suitability for surgery, beginning with a physical, a complete review of your medical history, X-rays, and other tests as appropriate, including MRIs, and CT scans. After reviewing the information gathered from these activities and the viability of other nonsurgical options, including physical rehabilitation, injections and medications, and other procedures, your provider will discuss with you whether total shoulder joint replacement surgery is right for your condition.
Shoulder joint replacement procedures involve modifying your existing shoulder socket, and then fitting the area with a prosthetic ball-stem instrument. This process varies with the type of surgery performed, as during total shoulder replacement, a metal ball-stem component and plastic socket are inserted into the affected joint area. A given patient’s condition affects the size of the prosthetics and whether the component can be press-fit or implanted with cement, depending on the softness of the surrounding bone. The presence of bone deficiency or sufficient amounts of cartilage in your shoulder socket or severe rotator cuff tendon damage also will influence the type of procedure you undertake.
Did You Know? Developing from a treatment for the most serious shoulder injuries over sixty years, today more than 50,000 Americans annually have shoulder joint replacement surgery to address arthritis and other issues affecting the shoulder (which is slightly more than half the number who receive knee and hip replacements each year).
Other non-total shoulder surgeries can also offer relief from pain and great functionality. During a stemmed hemiarthroplasty procedure, only the ball of the shoulder is substituted with a prosthetic ball and stem, typically when arthritis affects only the head of your upper arm bone and your shoulder socket otherwise retains its cartilage or has a diminished bone, or other injuries, such as rotator cuff tears, exist. When a resurfacing hemiarthroplasty is performed, the joint surface of your upper arm bone is replaced with an artificial cap (in the event of sufficient cartilage in your shoulder socket and no recent break near the top of your upper arm bone), which is often more advisable for more active or younger patients. Finally, when you have experienced near-complete arm instability, serious arthritis and rotator cuff tears, or a failed previous shoulder replacement procedure, reverse total shoulder replacement surgery may be the best option to ensure more complete arm mobility. During this procedure, the shoulder bone is affixed with a metal ball and a plastic socket is inserted within the upper arm bone, allowing for greater use of the shoulder and arm.
The post-surgical rehabilitation process for shoulder joint replacement surgery will entail intake of pain and other medications immediately following the procedure. To facilitate arm movement, you may be equipped with a pulley device so you can perform everyday activities during the first six weeks after the surgery when you should limit your shoulder movement. You will also work closely with a physical therapist during the several months following surgery in order to restore mobility, including performing arm and leg exercises that increase with intensity and type over time.
Once the patient is fully recovered, he or she can expect to return to normal activities with a decreased amount of pain as compared to before surgery. However, shoulder surgery restores about two-thirds of functionality in most people, back to their previous level of mobility before the joint damage occurred (which varies based upon the level of prior shoulder motion and whether any soft tissue was damaged). While it’s important to maintain an active lifestyle with moderate exercise, to achieve the best possible post-surgical results and limit the need for a later replacement joint, you should avoid high-stress athletic, occupational and everyday activities.