With advanced degenerative wear and tear arthritis the shoulder joint can deteriorate and begin to cause daily constant pain. Although shoulder replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. Shoulder arthritis can develop from osteoarthritis and post traumatic arthritis as well as chronic rotator cuff tear insufficiency.
Common activities such as raising the arms and even putting on a shirt or sweater can be painful or limited due to stiffness. You can even develop pain while at rest. When nonsurgical treatments are no longer helping to manage the pain then consultation with a surgeon takes place to consider shoulder replacement surgery. The loss of rotator cuff function due to chronic tears may necessitate consideration for reverse shoulder arthroplasty as this procedure can alleviate pain from arthritis and restore shoulder mobility with recruitment of other shoulders muscle.
The shoulder is a complex joint that has more motion than any other joint in the body. It is a suspensory joint, meaning muscles, tendons and ligaments maintain the joint alignment for proper positioning and function. The shoulder joint is a ball and socket joint that is encased in a capsule, surrounded by rotator cuff muscles and has a gel sac bursa between the glenohumeral joint (shoulder) and the acromion above.
The head of your humerus fits into a rounded socket in the shoulder blade called the glenoid. The bone ends are covered with articular cartilage which provides a slippery, smooth, frictionless surface that helps the bones glide easily across each other. The glenoid is ringed by strong fibrous cartilage called the labrum. The labrum forms a gasket around the socket, adding stability, and cushions the glenohumeral joint.
The glenohumeral joint is surrounded by bands of tissue called ligaments. They form a capsule that holds the joint together. Four tendons surround the shoulder capsule and help keep humeral head centered on the glenoid. This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus and attaches it to the shoulder blade.
There is a lubricating sac called a bursa between the rotator cuff and the acromion (bone on top of shoulder joint). The bursa helps the rotator cuff tendons glide smoothly when the arm is moved.
When is shoulder Replacement recommended?
There are several indications why your surgeon may recommend shoulder replacement surgery. People who benefit from shoulder replacement often have:
- severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing
- moderate to severe pain while resting. This pain may be severe enough to prevent sleep
- loss of motion and/or weakness in the shoulder
- failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone
injections, and/or physical therapy
- chronic rotator cuff tears with loss of function in addition to shoulder arthritis
What is total shoulder arthroplasty (TSA)?
The standard total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a high polymer plastic socket. These components come in various sizes. They may be either cemented or press fit into the bone. Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
What is reverse shoulder arthroplasty (RSA)?
Another type of shoulder replacement is known as reverse total shoulder replacement (reverse shoulder arthroplasty). Reverse shoulder replacement may be recommended for people who have:
- a completely torn rotator cuff that cannot be repaired
- tear arthropathy – the effects of severe arthritis and rotator cuff tearing
- a previous shoulder replacement that was unsuccessful
- severe shoulder pain and difficulty lifting your arm away from your side or over your head
- a complex fracture of the shoulder joint
- a chronic shoulder dislocation
- a tumor of the shoulder joint
For these individuals, a conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle. Not being able to lift the arm away from the side can be severely debilitating.
In reverse shoulder replacement, the socket and metal ball are switched: A metal ball is attached to the shoulder bone, and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.
Arthritis of the Shoulder – OrthoInfo – AAOS
Shoulder Joint Replacement – OrthoInfo – AAOS
Reverse Shoulder Replacement – OrthoInfo – AAOS
Reverse Shoulder Replacement Surgical Video – OrthoInfo – AAOS
Preparing for Joint Replacement Surgery – OrthoInfo – AAOS
Preventing Infection After Joint Replacement Surgery – OrthoInfo – AAOS
TJR Information Guide (pdf)