Partial Shoulder Replacement
Surgery is necessary when conservative means of treatment such as rest, anti-inflammatory medications, physical therapy have been ineffective in resolving symptoms.
Partial shoulder replacement is a surgical procedure during which the humerus (upper bone in the arm) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (socket) is left intact. This surgical procedure is indicated in severe shoulder osteoarthritis when only the ball of the joint is damaged. Osteoarthritis is a degenerative condition in which the cartilage that allows smooth movement in the joints wears away causing the adjacent bones to rub against each other resulting in pain and stiffness. Replacement of the damaged portion of the humerus relieves pain and reduces the friction as bone ends can no longer come in contact.
Sometimes the shoulder osteoarthritis involves both the shoulder bal! and shoulder socket and requires a total shoulder replacement. While the procedure may relieve your pain and other symptoms, there may also be associated risks and complications as with any major surgery.
Reverse Shoulder Replacement
Reverse total shoulder may be a needed replacement. Care is taken to protect muscular and neurovascular structures whose positions may be altered because of the previous surgery replacement, is an advanced surgical technique specifically performed when both shoulder arthritis and a rotator cuff tear are diagnosed.
The shoulder joint is a ball and socket joint formed by the union of the head of the upper arm bone (humerus) and the shoulder socket (glenoid). The rotator cuff is a group of four tendons that join the head of the humerus to the deeper shoulder muscles to provide stability and mobility to the shoulder joint.
When the rotator cuff is torn, it can cause wear and tear to the shoulder joint and lead to shoulder arthritis. Total shoulder joint replacement is usually ineffective in the treatment of rotator cuff tear arthropathy. If this surgery is used to treat rotator cuff arthropathy, it may result in loosening of the implants due to the torn rotator cuff. Reverse total shoulder replacement is specifically designed o be employed in such cases.
In reverse total shoulder replacement, the placement of the artificial components is essentially reversed. the humeral ball is placed in the glenoid cavity of the shoulder blade (scapula) and the plastic socket is placed on top of the arm bone. This surgery makes use of the deltoid muscle, the large shoulder muscle, to compensate for the torn rotator cuff.
Patients with rotator cuff arthropathy may feel pain (usually at night) and weakness in the involved shoulder. Patients may have had a prior rotator cuff repair or a history of multiple repairs. The most common symptom is the inability to raise the arm above the shoulder to perform overhead activities.
Reverse total shoulder replacement may be recommended for the following situations:
- completely torn rotator cuff that is not possible to repair and the patient cannot raise their arm
- presence of rotator cuff tear arthropathy
- Previous unsuccessful shoulder replacement
- Severe shoulder pain and difficulty in performing overhead activities
- Continued pain despite other treatments such as rest, medications, cortisone injections, and physical therapy
Reverse total shoulder replacement surgery is performed under general anesthesia. An incision over the affected shoulder to expose the shoulder joint. The humerus is then separated from the shoulder blade. The arthritic parts of the humeral head and the socket are removed. The artificial components are then fixed in place and include the metal ball that is screwed into the shoulder socket and the plastic cup is part of a stem and press fit into the upper arm bone. The wound is then closed with sutures. Patients typically stay in the hospital for one day. Physical therapy is usually recommended to increase mobility of the shoulder and improve flexibility and strength. It is generally recommended to avoid lifting heav Y objects and overhead activities for at least 6 weeks.
Total Shoulder Replacement
If non-surgical treatments, such as medications or physical therapy, are not efficient in reducing pain in the shoulder, shoulder replacement surgery may be recommended. shoulder replacement surgery is usually recommended for patients who suffer from severe shoulder pain that interferes with their daily activities, pain while the shoulder is resting, weakness of shoulder and lack of range of motion. The injured parts of the shoulder are removed and replaced with prosthetic components.
The shoulder is a highly movable body joint that allows various movements of the arm. It 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). In this surgery both the humeral head and the socket in the shoulder joint are removed and replaced with artificial prostheses.
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. Severe shoulder pain that restricts daily activities, pain during rest, Weakness and/or loss of motion may indications for Total Shoulder Replacement surgery
A medical history and thorough physical examination of the shoulder are used to diagnose a condition thoroughly to determine whether total shoulder replacement is a viable treatment. Imaging tests such as X-ray, CT scan, and/or MRI may also be ordered
The surgery is done under general anesthesia sometimes with additional regional anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The damaged humeral head is cut and a metal ball with a stem, is gently press fit into the humerus. Next, the arthritic part of the socket is prepared, and the plastic glenoid component is fixed in the shoulder bone. The subscapularis tendon is repaired, and the wound is closed after the artificial components are implanted.
After the surgery, pain medications and antibiotics are prescribed to control pain and prevent infection. A sling may be prescribed to secure the arm. Physical therapy may be started soon after the surgery to strengthen and provide mobility to the shoulder. Depending on the recovery, daily activities may be started two to six weeks after surgery.
Revision Shoulder Replacement
Total shoulder replacement is the replacement of the head of the humerus (upper arm bone) and the glenoid cavity (cavity of the shoulder blade) into which the humerus fits, with artificial prostheses to relieve pain, swelling and stiffness caused due to damage of cartilage at the articulating surfaces. The procedure usually has good results, but a revision surgery may occasionally be necessary due to persistent pain, infection, stiffness, weakness, instability, hardware loosening, malposition or fracture.
These complications occur with the formation of osteophytes (bone spurs), scar tissue, deficits in the supporting muscles, injury to nerves during surgery, soft tissue imbalance, and loose bodies. Complications may also occur when the components are too large, become loose or misplaced. Inadequate participation in the rehabilitation program and overstraining the repaired tendons too early are other causes for surgical failure.
Before considering revision surgery, your doctor will review your history and perform a thorough physical examination to identify the cause of failure and decide on the best approach to treatment.
Revision surgery is usually performed under general anesthesia. You are positioned to allow all possible variations in the treatment plan. Incisions are made to gain optimal access to the problem, and usually follow previous incisions with extensions made as necessary. Revision involves removing any impeding structures such as scar tissue. Muscles, tendons and ligaments that are stiff are released to improve range of motion and those that are injured are repaired using tendon grafts. III-fitting components are replaced or altered.
Fractures are stabilized by plates, screws and wires if needed. Infections are usually treated by debridement of soft tissue (removal of dead, infected tissue) and irrigation with antibiotic solution. In cases of chronic infections, components may need to be replaced. Care is taken to protect muscular and neurovascular structures whose positions may be altered because of the previous surgery