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Shoulder Replacement

Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with the artificial implants.

Indications

Shoulder joint replacement is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, avascular necrosis and failed former shoulder replacement surgery.

Diagnosis

The diagnosis of osteoarthritis is made on history, physical examination & X-rays. There is no blood test to diagnose Osteoarthritis (wear & tear arthritis).

Procedure

During the surgery an incision is made over the affected shoulder to expose the shoulder joint. The humerus is separated from the glenoid socket of the scapula. The arthritic part of the humeral head and the socket is removed and prepared so as to take the artificial components. The glenoid component is then pressed into the socket, and the humeral component is cemented into the upper arm bone. The humeral head component made of metal is then placed on the humeral stem. The artificial components are fixed in place. The joint capsule is stitched together. The muscle and tendons are then repaired and the skin is closed.

Risks and Complications

Possible risks and complications specific to shoulder joint replacement surgery include:

  • Infection around an implanted joint
  • Dislocation or instability of an implanted joint
  • Fracture of the humerus or scapula
  • Damage to nerves or blood vessels
  • Blood clots (deep vein thrombosis)
  • Wound irritation
  • Arm length discrepancies
  • Wearing of the joints
  • Scar formation

Reverse Shoulder Joint Replacement

Reverse Shoulder replacement is an alternative surgery for patients who have torn their rotator cuffs and have developed severe arthritis or who have had a previous total shoulder replacement that has failed to relieve their pain. Rotator cuff is the group of four tendons that join the head of the humerus (arm bone) to the deeper muscles and provides stability and mobility to the shoulder joint.

The surgery is done under regional or general anesthesia. An incision is made over the affected shoulder to expose the shoulder joint. In normal procedure, metal ball is placed at end of upper arm bone and the socket into the shoulder bone. However in a reverse shoulder replacement, the metal ball is attached to the shoulder bone and the socket is placed at the end of the upper arm bone. By switching the prosthetics, the patient will now be able to use their deltoid muscle, instead of the torn rotator cuff, to enable lifting of their arm. After the artificial components are implanted the joint capsule is stitched and the wound is closed.

Reverse Shoulder replacement surgery is performed through a larger open incision due to the complexity of the operation and usually involves a hospital stay of a few days.

Partial Shoulder Replacement

Partial shoulder replacement, also called shoulder hemiarthroplasty is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact. This surgical procedure is indicated in severe, persistent conditions of shoulder osteoarthritis in which the only the humeral head or 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 bone to rub against each other resulting in pain and stiffness. In such conditions, replacement of the damaged portion of the humerus will reduce the friction as bone ends can no longer come in contact and thus relieve pain.

Surgery remains as a sole treatment option when all possible conservative means of treatment such as rest, anti-inflammatory medications, physical therapy have been ineffective in resolving your symptoms. While the procedure may relieve your pain and other symptoms, there may also be associated risks and complications as with any major surgery. Potential risks and complications that may occur following shoulder hemiarthroplasty include infection, instability, fractures of the humerus or scapula, shoulder stiffness, damage to the blood vessels and nerves.

Conventional Shoulder Replacement

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Damage of the cartilage in the shoulder joint causes shoulder arthritis. In an arthritic shoulder

  • The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis
  • The capsule of the arthritic shoulder is swollen
  • The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.
  • Bone spurs or excessive bone can also build up around the edges of the joint

Doctors diagnose arthritis with a medical history, physical exam and X-rays of the shoulder. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.

Your doctor may recommend anti-inflammatory medicine and occupational therapy or physiotherapy. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. Common surgery for treatment of shoulder arthritis may be total shoulder arthroplasty (replacement of the damaged joint).

Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with the artificial joint parts. There are two types of total shoulder replacements: a conventional shoulder replacement and a reverse shoulder replacement.

Conventional total shoulder arthroplasty is a shoulder replacement surgery for patients who suffer from osteoarthritis but have intact rotator cuff. A conventional prosthesis mimics the normal anatomy of the shoulder. The surgery involves replacing the round part of the joint with a metal ball and resurfacing the socket with a plastic cup. The aim of the surgery is to restore function to the shoulder joint by removing the damaged cartilage and bone.