Shoulder Joint Replacement (arthroplasty)

Shoulder prothesis


Shoulder joint arthroplasty is a surgical procedure that involves replacing the damaged or diseased parts of the shoulder joint with artificial components or implants. The goal of this surgery is to relieve pain, restore function, and improve mobility of the shoulder joint. There are different types of shoulder joint arthroplasty, including partial or total shoulder replacement, reverse total shoulder replacement, and hemiarthroplasty. The type of arthroplasty recommended will depend on the severity of the condition, the extent of joint damage, and the patient’s overall health.

Although shoulder joint replacement is not as common as knee or hip replacement, it has proven to be equally successful in relieving joint pain. Initially, shoulder replacement surgery was performed in the United States during the 1950s to treat severe shoulder fractures. Over the years, the procedure has become an effective solution for several painful shoulder conditions, such as various forms of arthritis.

When medications and lifestyle changes are no longer effective in relieving pain, shoulder joint replacement surgery may be a viable option. Joint replacement surgery is a safe and successful procedure that can alleviate pain and help patients return to their daily activities. Whether you are exploring treatment options or have already decided to undergo shoulder joint replacement surgery, our consultants will provide you with a better understanding of this procedure and possible options of treatment.

Diseases treated with the Shoulder Joint Replacement

Shoulder joint replacement surgery is an option for those with several conditions that cause shoulder pain and disability, which may include the following:

  • Osteoarthritis (Degenerative Joint Disease): This is a type of arthritis that occurs due to age-related wear and tear. The cartilage that cushions the bones of the shoulder becomes worn out, causing the bones to rub against each other and resulting in stiffness and pain in the shoulder joint.
  • Rheumatoid Arthritis: This is a chronic inflammatory disease that causes the synovial membrane surrounding the joint to become inflamed and thickened. This inflammation can damage the cartilage, leading to pain and stiffness. It is the most common form of a group of disorders called inflammatory arthritis.
  • Post-Traumatic Arthritis: This type of arthritis may occur following a serious shoulder injury, such as a fracture or a tear of the shoulder tendons or ligaments. This can damage the articular cartilage over time, leading to shoulder pain and reduced function.
  • Rotator Cuff Tear Arthropathy: This condition may develop when a patient has a large, long-standing rotator cuff tear. The changes in the shoulder joint due to the tear may result in arthritis and destruction of the joint cartilage.
  • Avascular Necrosis (Osteonecrosis): This painful condition occurs when the blood supply to the bone is disrupted, causing the bone cells to die. It can ultimately lead to the destruction of the shoulder joint and arthritis. Risk factors for avascular necrosis include chronic steroid use, deep sea diving, severe shoulder fracture, sickle cell disease, and heavy alcohol use.
  • Severe Fractures: A severe fracture of the shoulder is another reason why people may undergo shoulder replacement surgery. When the upper arm bone is shattered, it may be difficult for a doctor to put the pieces back together. In addition, the blood supply to the bone pieces can be disrupted. Shoulder replacement surgery may be recommended in such cases, especially for older patients with osteoporosis who are at higher risk for severe shoulder fractures.
  • Failed Previous Shoulder Replacement Surgery: Although rare, some shoulder replacements may fail due to implant loosening, wear, infection, or dislocation. In such cases, a second joint replacement surgery, known as revision surgery, may be necessary.

Types of Shoulder Joint Replacement

To ensure a successful shoulder replacement surgery, it’s important that it is performed by an experienced surgical team. There are different types of shoulder replacements available, and your surgeon will carefully evaluate your condition to determine the most suitable option for you. They will discuss the type of implant that will be used and why it is the best choice for you.

One type of shoulder replacement is total shoulder replacement, which involves replacing the arthritic joint surfaces with a metal ball and a plastic socket. The size and type of components used may vary depending on the patient’s bone quality. Another option is stemmed hemiarthroplasty, in which only the ball is replaced with a metal ball and stem. This may be recommended for patients with a severely fractured humeral head or weakened bone in the glenoid.

Resurfacing hemiarthroplasty is another type of shoulder replacement, which involves replacing only the joint surface of the humeral head with a cap-like prosthesis without a stem. This option is suitable for patients with intact cartilage on the glenoid and a desire to preserve humeral bone.

For individuals with completely torn rotator cuffs or severe arthritis and rotator cuff tearing, a reverse total shoulder replacement may be recommended. In this procedure, a metal ball is attached to the shoulder bone and a plastic socket to the upper arm bone, allowing the deltoid muscle to lift the arm instead of the torn rotator cuff.

Preparation for Shoulder Joint Replacement

Before considering shoulder replacement surgery, it is recommended to have an evaluation with an orthopaedic surgeon. The evaluation process consists of several components, which include a medical history, physical examination, X-rays, and possibly other tests like blood tests, CT scans, MRI scans, or bone scans. During the evaluation, the orthopaedic surgeon will gather information about your general health, the extent of your shoulder pain, and your ability to function. The physical examination will assess your shoulder motion, stability, and strength, while X-rays help determine the extent of damage in your shoulder. Once the evaluation is complete, the orthopaedic surgeon will discuss the results with you and suggest whether shoulder joint replacement is the best way to relieve your pain and improve your function. Other treatment options like medications, injections, physical therapy, or other types of surgery will also be considered and discussed.

Shoulder Joint Replacement Procedure

Shoulder replacement surgery typically involves the following steps:

  • Anesthesia: The patient will be given general anesthesia or regional anesthesia, which numbs the arm and shoulder, but allows the patient to remain awake.
  • Incision: The surgeon will make an incision in the front of the shoulder. The size of the incision may vary depending on the type of replacement being performed.
  • Joint Access: The surgeon will then carefully move the muscles and tendons out of the way to access the shoulder joint.
  • Preparation of the Glenoid: If performing a total shoulder replacement, the surgeon will remove the damaged cartilage and bone from the glenoid, which is the socket portion of the shoulder joint.
  • Preparation of the Humeral Head: The surgeon will then remove the damaged cartilage and bone from the humeral head, which is the ball portion of the shoulder joint.
  • Implantation: The surgeon will then implant the prosthetic components, which may include a metal ball and stem for the humeral head, and a plastic socket for the glenoid. The components may be cemented or press-fit into the bone.
  • Testing: The surgeon will then test the range of motion and stability of the new shoulder joint.
  • Closure: The surgeon will then close the incision with sutures or staples, and cover it with a bandage.

After surgery, the patient will be closely monitored in the hospital for a few days, and may undergo physical therapy to help restore range of motion and strength to the shoulder joint. It may take several months for the shoulder to fully heal and for the patient to regain full function of the joint. A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy soon after the operation. Your surgeon or physical therapist will provide you with a home exercise program to strengthen your shoulder and improve flexibility.

Benefits of Shoulder Joint Replacement

The benefits of a shoulder replacement surgery can include:

  • Pain relief: Shoulder replacement surgery can help to alleviate the pain and discomfort that is often associated with shoulder arthritis and other conditions that affect the shoulder joint.
  • Improved range of motion: After surgery, patients often experience improved range of motion and greater shoulder mobility, which can help to improve their overall quality of life and ability to perform daily activities.
  • Increased strength: Following a period of rehabilitation and physical therapy, patients may also experience increased shoulder strength, which can allow them to perform activities that were previously difficult or impossible.
  • Improved sleep: Shoulder pain can often interfere with sleep, but after shoulder replacement surgery, patients may experience improved sleep due to reduced pain and discomfort.
  • Better mood and mental health: Chronic pain can take a toll on mental health and well-being, and alleviating pain through shoulder replacement surgery may improve mood and overall mental health.
  • Improved joint function: Shoulder replacement surgery can restore the function of a damaged or diseased joint, allowing patients to participate in physical activities that they were previously unable to do.

It’s important to note that every patient’s experience with shoulder replacement surgery will be unique, and there may be additional benefits and risks that are specific to individual cases. It’s always best to consult with an orthopedic surgeon to discuss the potential benefits and risks of shoulder replacement surgery based on your individual circumstances.