What is Shoulder Replacement?
Shoulder replacement is a surgery performed to remove the damaged articulating parts of the shoulder joint and replace them with artificial prostheses.
Normal Anatomy of the Shoulder
The shoulder 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).
Indications for Shoulder Replacement
Total shoulder joint replacement surgery is indicated for conditions such as osteoarthritis or rheumatoid arthritis when medication, injections, physical therapy and activity changes do not help relieve pain. 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 for Shoulder Replacement
To decide whether total shoulder replacement is a good option for you, your surgeon will evaluate your condition thoroughly. Your surgeon reviews your medical history and performs a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI are ordered.
Shoulder Replacement Procedure
The shoulder replacement surgery is performed under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as open surgery where a large incision is made or as a minimally invasive surgery that requires a smaller incision.
The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem, is gently press fit into the humerus. Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone. After the artificial components are implanted, the joint capsule is stitched and the wound is closed
Post-operative Care after Shoulder Replacement
After the surgery, pain medications and antibiotics are prescribed to control pain and prevent infection. Your arm may be secured in a sling or cast. 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 associated with Shoulder Replacement
The shoulder replacement surgery is a very safe procedure; however, as with any surgical procedure, there may be risks involved, which include:
- 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