Total Anatomic Shoulder 'Replacement' Arthroplasty

When you experience serious shoulder damage due to injury and/or arthritis that causes pain and impairs the ability to use your arm, you may need surgery. Shoulder replacement surgery is a safe and effective way to reliably restore function and comfort and eliminate disability.

Shoulder Anatomy

The shoulder is a ball and socket joint made of the head of the upper arm bone (the "humerus") which fits into the curved socket in the shoulder blade called the glenoid socket. In a healthy shoulder the socket and the head of the humerus are lined with cartilage, which is designed to provide smooth, pain free movement and to protect the ends of the bones from wearing against each other.

The rotator cuff is a group of muscles, tendons and ligaments that enclose the joint for stability and support and allows you to raise and rotate your arm. Shoulder anatomy is designed to allow the greatest range of motion of any joint in the body.

What is osteoarthritis?

Osteoarthritis (OA) is a degenerative disease of the joint, that destroys the cartilage that lines the shoulder socket and the head of the upper arm bone. When that cartilage is worn away the bones rub against each other and cause significant pain and disability. OA typically occurs with age but can also result after a traumatic shoulder injury or from a damaged rotator cuff.

What is Total Shoulder Arthroplasty?

Shoulder arthroplasty is outpatient shoulder joint replacement surgery to swap damaged bone with man-made replacements.  An anatomic shoulder replacement is designed for patients who have severe shoulder pain due to end-stage bone on bone shoulder arthritis, rheumatoid arthritis and/or a fracture of the upper arm bone often due to osteoporosis.

It is called an anatomic shoulder replacement because the parts of the shoulder that are damaged by osteoarthritis - the curved space in the shoulder blade, and the head of the upper arm bone - are replaced with anatomically correct components.

The term "total" implies that both the head of the humerus and the socket are replaced with artificial implants.  The goal is to reduce pain and restore function. Total shoulder replacement is a very successful surgery to restore pain free motion and function.

Who is a good candidate for total shoulder replacement?

Good candidates are patients who have osteoarthritis of the shoulder and an intact rotator cuff. To be a good candidate for a total shoulder must have a healthy well-functioning rotator cuff. If not, they are not a candidate for a total shoulder, but may be a candidate for a reverse should replacement.

What are the symptoms that indicate the need for a shoulder replacement?

Symptoms include pain and an impaired ability to perform daily life functions such as brushing your hair, dressing, and raising the arm to reach an object on a shelf, severe shoulder pain that often becomes worse at night and interferes with sleep. Usually, severe shoulder stiffness and a grinding sensation accompany and aggravate the pain.

Diagnosis

Dr. Johnston will recommend a total shoulder based upon your medical history, physical exam, and shoulder function.  Imaging studies will reveal the condition of your bones, arthritis and soft tissues including your rotator cuff. He will ask about your symptoms including functional limitations, and pain.  If there is a potential for nerve damage, Dr. Johnston will order testing to evaluate the nerves.

He may recommend a trial of conservative management such as heat and over the counter pain medications if the osteoarthritis is at an early stage. If pain persists, he may offer a steroid injection into the shoulder joint and order a course of physical therapy.  When pain and function cannot be improved without surgery, Dr. Johnston will recommend a total shoulder replacement.

The procedure

Total shoulder replacement is a surgical procedure accomplished with regional or general anesthetic. The damaged head of the upper arm bone is replaced with a prosthetic ball, and the joint socket is replaced with prosthetic socket.

Total shoulder replacement may be performed as an inpatient or an outpatient. If performed as an inpatient, you may be in the hospital for 3 days after surgery. Outpatient total shoulder replacement is a safe and effective alternative to impatient surgery for appropriately selected patients. Improvements in implant design, surgical technique and operative management have resulted in a substantial reduction in the length of stay and post-operative complications.

There is no difference in complication rates between outpatient and inpatient surgery.

Total shoulder is a very successful surgery to restore function for patients with end stage arthritis. Studies report that 95% of patients are pain and stiffness free with shoulder function and can restore strength and range of motion.

After surgery

You will awaken with your arm in a sling. Rehabilitation is begun immediately on the day of surgery; and continues at home and with a physical therapist 2-4 weeks after surgery.

Replacement parts last between 15-20 years.

Dr. Johnston is a board-certified shoulder and elbow specialist and expert in complex surgeries of the shoulder and elbow. He was also Fellowship trained at the prestigious TJU Rothman Institute in Philadelphia. Dr. Johnston is committed to his patients and helping them achieve a fully functional and pain free quality of life. He has offices in Leonardtown and White Plains Maryland. Contact Dr. Peter Johnston to schedule a consultation to receive the correct diagnosis and all your treatment options including state - of - the - art procedures and surgical techniques.