Shoulder Arthoplasty

Anatomy:

The shoulder, a ball-and-socket joint, is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collar bone (clavicle).  The humeral head, or the ball, fits into a shallow socket on your scapula called the glenoid. In a healthy shoulder the surfaces of the ball and socket joint are covered with smooth cartilage and a synovial membrane which produces lubricant that allows for easy, pain free movement of the shoulder joint.

What is Shoulder Joint Replacement?

Shoulder Replacement or Total Shoulder arthroplasty is a procedure performed to replace the diseased or damaged ball and socket joint of the shoulder with plastic and metal components, called a prosthesis.

Common Diagnoses:

Common conditions that lead patients and their surgeon to consider shoulder joint replacement are:

1.      Osteoarthritis (degenerative joint disease)

2.      Rheumatoid Arthritis

3.      Post-Traumatic Arthritis

4.      Rotator Cuff Tear Arthropathy

5.      Avascular Necrosis

6.      Severe proximal humerus Fractures

7.      Failed previous shoulder replacement surgery

How do you know if you need a shoulder replacement?

You may be experiencing: 

· Consistent and severe pain that interferes with your ability to preform normal, daily activities and pain that is keeping you awake at night. 

· Loss of motion and/or weakness in the shoulder that has lead you to change your lifestyle and stop doing activities that you love.

· You may have also failed conservative, non-operative treatment (ie. Anti-inflammatory medications, cortisone injections, or physical Therapy)

· The two main goals of surgery are to relieve pain and restore function.  Electing not to have surgery can lead to increased pain, increased loss of function, increased difficulty preforming daily activities and in rare instances, further bone erosion that can make surgical correction impossible.

Surgical Options:

When it comes to possibly needing a shoulder replacement—there are a number of different options for each patient situation.

Total Shoulder Replacement

· For Patients with end-stage osteoarthritis and an intact rotator cuff are typically good candidates

· Involves preserving the natural anatomy of the shoulder joint by replacing the humeral head with a metal ball and putting in a polyethylene socket.

Hemiarthroplasty

· For patients with a damaged or diseased humeral head but a normal socket

· Involves replacing only the humeral head

Reverse Total Shoulder Replacement

· For patients with complete rotator cuff tears, severe arthritis caused by rotator cuff tear (cuff tear arthropathy), or patients with a prosthesis that has failed.

· Involves reversing the anatomy within the joint by switching the locations of the ball and socket. In this scenario, the deltoid muscle takes over the motion of the shoulder.

Complications of Surgery

· Infection

· Dislocation of the shoulder

· Bone fracture

· Prosthesis problems

· Nerve Injury

· Anesthetic risks

Specifics about the operation:

· Your procedure will be done at MedStar St. Mary’s Hospital in Leonardtown, MD.  Some cases can also be done as an outpatient at the Leonardtown Surgery Center.

· In regards to anesthesia, you will first receive a regional nerve block that will numb the operative arm. The block can last 12-36 hours, but varies between patients.  You will also be under general anesthesia. 

· The procedure typically lasts 1.5 to 2 hours.  Pre-op and recovery may add several hours to this time. 

· Your stay at the hospital will most likely be 1 night. Some cases, like those who plan on attending rehab, will required a long hospital stay.  Case management will be available for guidance at the hospital.