Shoulder replacement procedures using minimally invasive surgical techniques may provide several potential benefits to patients suffering from severe shoulder arthritis or chronic unrepairable rotator cuff tears.
The shoulder joint is a very unique joint consisting of a ball called the humeral head and a flat surface called the glenoid. This is very different than the hip joint that is made up of a ball and a socket. Stability of the shoulder is derived from the soft tissues. Because of this unique structure the shoulder allows for a significant range of motion. Like other joints of the body, the shoulder joint can wear out over time related to injuries, wear and tear and genetic factors.
Cartilage, a tough protective tissue, covers the ends of the bones to decrease the friction caused during movement. While cartilage protects the ends of the bones, synovial fluid bathes the remaining surfaces of the joint to protect from wear, allowing for smooth movement of the joint. Arthritis changes of the shoulder results in decreased range of motion, pain and sometimes clicking and popping.
- Shoulder Replacement Surgery
- Shoulder Surgery in Minnesota
Symptoms of Arthritis of the Shoulder
The most common form of hip arthritis is osteoarthritis. Osteoarthritis (OA) is a degenerative joint disease and the leading cause of hip pain. Genetics, previous injuries/surgeries, or congenital defects can lead to osteoarthritis of the hip joint. OA leads to the breakdown of bony cartilage, causing an uneven joint surface that can lead to catching, locking, and significant pain in more advanced cases. Common complaints include groin pain that may radiate down the inner thigh, stiffness after prolonged sitting, and pain during activity. In advanced cases, patients may experience pain at night as well. Other causes of shoulder arthritis include post-traumatic, rotator cuff arthropathy and avascular necrosis.
As arthritis progresses, it can result in extensive bone damage and may require more invasive procedures and/or corrective surgery. Dr. O’Keefe is dedicated to providing patients with the most advanced treatment options for shoulder arthritis including arthroscopic debridement and capsular release, shoulder resurfacing, total shoulder replacement and reverse shoulder replacement for patients who have both shoulder arthritis and damage to their rotator cuff.
Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain.
Shoulder replacement surgery was first performed in the United States in the 1950s to treat severe shoulder fractures. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis.
Today, about 53,000 people in the U.S. have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality. This compares to more than 900,000 Americans a year who have knee and hip replacement surgery.
If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.
Whether you have just begun exploring treatment options or have already decided to have shoulder joint replacement surgery, this article will help you understand more about this valuable procedure.
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid.
The bones of a healthy shoulder joint.
The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder.
The muscles and tendons that surround the shoulder provide stability and support.
Is Shoulder Replacement for You?
The decision to have shoulder replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopedic surgeon.
There are several reasons why your doctor may recommend shoulder replacement surgery. People who benefit from surgery often have:
· Severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
· Moderate to severe pain while resting. This pain may be severe enough to prevent a good night’s sleep.
· Loss of motion and/or weakness in the shoulder.
Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.
Shoulder Replacement Options
Shoulder replacement surgery is highly technical. It should be performed by a surgical team with experience in this procedure.
There are different types of shoulder replacements. Your surgeon will evaluate your situation carefully before making any decisions. He or she will discuss with you which type of replacement would best meet your health needs. Do not hesitate to ask what type of implant will be used in your situation, and why that choice is right for you.
Total Shoulder Replacement
The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.
A total shoulder joint replacement.
These components come in various sizes. They may be either cemented or “press fit” into the bone. If the bone is of good quality, your surgeon may choose to use a non-cemented (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 (socket) component is implanted with bone cement.
Implantation of a glenoid component is not advised if:
- The glenoid has good cartilage
- The glenoid bone is severely deficient
- The rotator cuff tendons are irreparably torn
Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
These x-rays were taken before and after total shoulder replacement surgery for osteoarthritis.
Depending on the condition of your shoulder, your surgeon may replace only the ball. This procedure is called a hemiarthroplasty. In a traditional hemiarthroplasty, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty.
Some surgeons recommend hemiarthroplasty when the humeral head is severely fractured but the socket is normal. Other indications for a hemiarthroplasty include:
- Arthritis that only involves the head of the humerus with a glenoid that has a healthy and intact cartilage surface
- Shoulders with severely weakened bone in the glenoid
- Some shoulders with severely torn rotator cuff tendons and arthritis
Sometimes, surgeons make the decision between a total shoulder replacement and a hemiarthroplasty in the operating room at the time of the surgery.
Studies show that patients with osteoarthritis get better pain relief from total shoulder arthroplasty than from hemiarthroplasty.
Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a stem. With its bone preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard stemmed shoulder replacement.
Resurfacing hemiarthroplasty may be an option for you if:
- The glenoid still has an intact cartilage surface
- There has been no fresh fracture of the humeral neck or head
- There is a desire to preserve humeral bone
For patients who are young or very active, resurfacing hemiarthroplasty avoids the risks of component wear and loosening that may occur with conventional total shoulder replacements in this patient population. Due to its more conservative nature, resurfacing hemiarthroplasty may be easier to convert to total shoulder replacement, if necessary at a later time.
This x-ray shows the cap-like prosthesis used in resurfacing hemiarthroplasty.
Reverse Total Shoulder Replacement
Another type of shoulder replacement is called reverse total shoulder replacement. Reverse total shoulder replacement is used for people who have:
- Completely torn rotator cuffs with severe arm weakness
- The effects of severe arthritis and rotator cuff tearing (cuff tear arthropathy)
- Had a previous shoulder replacement that failed
- An x-ray of a reverse total shoulder replacement.
For these individuals, a conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle. Not being able to lift one’s arm away from the side can be severely debilitating.
In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.
Dr. Patrick O’Keefe is committed to excellence and is dedicated to providing his patients with the highest quality orthopedic care to all of his patients. Using innovative and cutting-edge technology, including minimally invasive and arthroscopic techniques, Dr. O’Keefe specializes in the treatment of acute and chronic shoulder conditions. To make an appointment with Dr. O’Keefe please call his office at (763) 441-0298.