Shoulder replacement surgery can be a life changing for people with significant shoulder pain and dysfunction. Shoulder replacement can be a great solution for common shoulder problems such as arthritis (degenerative joint disease) and rotator cuff tears that are unable to be repaired. In general, shoulder replacement involves removing just the ends of the bones and replacing them with metal and plastic. This allows patients to regain their range-of-motion and minimize pain, often allowing them to resume all previous activities.
In the United States, there are two main types of joint replacements. Your surgeon will decide which type of replacement is best for you.:
1) Anatomic Total Shoulder Arthroplasty (replacing the humeral ball with a metal ball and placing a plastic piece on the socket) and
2) Reverse Total Shoulder Arthroplasty (replacing the humeral ball with a socket and placing a metal ball on the socket).
Anatomic Total Shoulder Arthroplasty has long been the standard for shoulder surgery. It was developed in the 1950s by a surgeon by the name of, Dr. Charles Neer. This type of shoulder replacement requires replacing both the ball and the socket; versus, a partial replacement (hemiarthroplasty) when only the ball is replaced. Anatomic total shoulder replacement is often recommended for individuals with arthritis in the shoulder. It is very successful in relieving pain and improving function. Success rates are approximately 90%.
The key to a successful a total shoulder replacement, however, is a good and healthy rotator cuff. The rotator cuff tendons are a group of tendons that power the shoulder overhead. These tendons must be intact for a shoulder replacement to function properly. If the rotator cuff is worn, torn or in poor shape, a traditional shoulder replacement will not be successful in providing pain relief and restoring pain-free motion and function. This is where your doctor, may recommend a reverse total shoulder arthroplasty, This is a newer procedure with implants just approved in the United States in 2006. However, reverse total shoulder replacement has been used in Europe for decades.
The reverse total shoulder replacement has revolutionized shoulder replacement surgery by replacing the humeral ball with a socket and placing a metal ball on the socket.
We this configuration, we now have a great option for patients with a poor rotator cuff and irreparable tendons, a condition which used to preclude patients from a shoulder replacement. The reverse total shoulder replacement works differently, because it does not rely on the rotator cuff tendons to help stabilize the shoulder. The geometric configuration of the implant does this instead. With this implant the deltoid muscle is able to power the shoulder overhead. Now, we can treat patients with excellent results when previously they did not have any good options. Another benefit of reverse total shoulder replacement is that individuals with bone loss from arthritis can also undergo a shoulder replacement. The reverse total shoulder replacement can be an effective tool for bone loss when a traditional shoulder replacement can be at higher risk for failure. Also, with the reverse should replacement, if the rotator cuff tendons tear over time (with natural aging), it will not typically affect function of the shoulder like a traditional shoulder replacement.
With both traditional total shoulder and reverse total shoulder replacements, patients often find that surgery is less complicated and less onerous than they think. The truth is, most patients only spend one night in the hospital and go home the next day. Some younger and healthy patients can even go home the same day of surgery.
During the first six weeks after surgery, patients will be instructed to wear a sling, but they can remove the for hours at a time when performing waist level activities. Activities such as bathing, eating, dressing, watching TV, and computer work can be done immediately without wearing the sling. Patients are also surprised to learn that they can drive as soon as they are off narcotics. Patients usually start therapy within a couple of weeks after their surgery, and they will continue therapy for about four months. For reverse total shoulder replacement patients, they are usually able to have unrestricted activity at 4 ½ months. For total shoulder replacement patients, we recommend unrestricted activity at 6 months.
Success rates for both types of shoulder replacement are 90% or better. This means patients will see significant improvement in range-of-motion, but more importantly, pain relief. Both types of shoulder replacements are fantastic operations for patients to regain their lifestyle and restore their activity level.
Dr. Mitchell Fagelman is a board-certified orthopedic surgeon who specializes in sports medicine and is an expert in diagnosing and treating shoulder pain.