Pain in the shoulder can be caused by a number of pathologies. The range of treatments and surgical interventions are equally as broad. We do as much as we can to avoid shoulder replacement surgery, but in cases of severe shoulder fractures and advanced arthritis, this may be the best solution for pain relief and return of function. The following is an introduction to some of the options available in shoulder arthroplasty.
When a joint is so worn out that nothing else will help the pain and disability the joint may need to be replaced. The medical word for joint replacement is arthroplasty. You may know people who have had a total knee replacement or a total hip replacement. These common procedures replace the knee and hip joints with metal and polyethylene (plastic) components to restore function. Though not as common, similar procedures can be performed with the shoulder. The three main procedures to introduce are the shoulder hemiarthroplasty, total shoulder replacement, and reverse total shoulder arthroplasty.
The shoulder can be thought of as a ball and socket joint. The ball is at the top of the arm bone or humerus. Shoulder hemiarthroplasty involves placing a stemmed prosthesis or metal component as a replacement of the ball. The “hemi” in hemiarthroplasty means that you are only replacing half of the joint or one side of the joint. In this case, the socket is left alone. This procedure is used when the ball has become broken off by a fall or in cases of mild arthritis where the socket is in good condition.
With younger patients, the use of a resurfacing hemiarthroplasty can be employed. In this surgery, more of the original bone is left as a metal cap is placed at the end of the ball joint of the shoulder. This cap has a short stem that is just over one inch and length and provides the stability needed to maintain its position. Often with resurfacing techniques, the device has a porous surface to allow bone to grow into the device and provide additional stability. One of the advantages of the resurfacing procedure is that it preserves more of the original bone leaving options open for total shoulder replacement if needed in the future.
A total shoulder replacement is a more complicated procedure than a hemiarthroplasty or a resurfacing hemiarthroplasty because the orthopedic surgeon is now replacing both sides of the joint. A total shoulder involves a stemmed metal component to replace the ball of the shoulder, but also involves a polyethylene or plastic component to replace the socket which is called the glenoid. The glenoid is the concave extension of the shoulder blade that articulates or connects to the ball of the shoulder. This procedure is used with severe osteoarthritis involving both sides of the shoulder joint. Which of these two procedures is best for a particular patient is based on a number of factors; including the opinion of both the orthopedic surgeon and the patient.
In some situations, the patient has arthritis of the shoulder, but also has weakness because of a large rotator cuff tear which is not repairable. While a traditional shoulder replacement may help the pain, it may not cure the weakness. This has led to the development of an emerging technique in shoulder replacement surgery called the reverse total shoulder arthroplasty. With this technique the usually concave glenoid surface is replaced with a ball joint and the shoulder joint end of the humerus is replaced with a concave shallow cup. The reason this works is complex, but it can provide strength to the shoulder so the arm can be raised up. This procedure is far less common as compared to the two previously described.
As mentioned at the beginning of this article, we do everything we can to avoid the need for this type of surgery. Often managing shoulder pain starts with non-surgical interventions that may delay or eliminate the need for surgery. A great place to start is with a visit to our office where you can be seen by one of our orthopedic surgeons or our specially trained physician assistants or nurse practitioner.