Shoulder replacement (arthroplasty) has become more and more feasible since it was first introduced years ago. Traditionally, upper extremity surgeons have recommended a “Total Shoulder Replacement” when it was felt that the socket—the glenoid—was involved in the arthritic process, otherwise only the humerus was replaced for arthritis. Though glenoid-replacement components and fixation techniques have been regarded as the “weak link” in terms the most common implant-related source of complications after a total replacement, advancements have really improved outcomes following replacement of both the humerus and the glenoid. Indeed, when the rotator cuff is in tact, anatomic total shoulder repalcement is very successful; in fact, there is now consensus that Totals do better than Hemiarthroplasty (when only the humerus is replaced.) When the cuff is not functioning due to atrophy or an irreparable tear a Reverse shoulder implant is now the best option in most cases (see the Articles regarding reversed shoulder arthroplasty for more information).
The newest developments in the area of “glenoid resurfacing” have centered around eliminating the need for cementation—particle wear from the plastic glenoid component and the presence of cement for fixation seem not to mix well long-term in all cases. I now use a pegged glenoid with a central peg into which bone can grow for long term stabilization. I have attached 2 articles from the JSES (J Shoulder and Elbow Surgery) that highlight favorable outocomes data related to the pegged glenoid implant, suggesting the validity of our expectation that bony ingrowth into the central peg occurs, and revealing a diminished lucency rate compared to keeled implants.
Anatomic “Total Shoulder Replacement” continues to be a superb option in patients with shoulder arthritis, particulary osteoarthritis, because it replaces like with like---the implant replaces the "anatomy" unique to you, thus the term "anatomic" replacement. . Restoration of functional range of motion and pain relief are the anticipated result (see Total shoulder arthroplasty case examples). The operation takes between 90 minutes and 2 hours in most cases, requires an in patient stay for a day or two, and usually physical therapy will begin within the first week after surgery. Restoration of functional motion usually takes between 2 to 4 months.
I have attached an article below which describes current practice guidelines developed by the American Academy of Orthopaedic Surgeons (AAOS).
For my comment, please see my POST on the FORUMS section of this website, entitled " Practice Guidelines Regarding Treatment of Shoulder Osteorthritis: My Commentary".
If you have shoulder pain due to arthritis, and you are looking for pain releif and better range of motion, a shoulder replacement may be a very good option for you.
2 comments
Deloris 4/2/11 at 11:48 am
I had a total shoulder replacement performed 8 months ago, and I have an ongoing problem with dislocation now. My doctors have recommended a 2nd surgery to try to stabilize the replacement. I am 75 and have not been able to use my arm above my shoulder now because it feels as though it slips out. Just wondered whether you have ever had to deal with this problem in your experience, and what you think my options are.
mtomaino 4/2/11 at 1:07 pm
Deloris
Thanks for question; it prompted me to provide a more comprehensive response which you can read by clicking on the "Anatomic Total Shoulder Arthroplasty" topic at the top right of this page. The question and response are at the top.
In short, I would need to see your x-rays and have a sense of your exam before in order to provide you with a sense of what the problem is and what the best solution might be. Best,
Dr T