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Shoulder Replacement

To understand how a Shoulder Replacement Surgery, also known as Shoulder Arthroplasty or Glenohumeral Arthroplasty is performed, one must understand the brief anatomy of the Shoulder. Shoulder is made up of three bones – upper arm bone (humerus), shoulder blade (scapula) and your collarbone. The shoulder is a ball and socket joint. The head (ball) of your upper arm bone fits into a shallow socket (glenoid) in your shoulder blade. This ball and socket construction allows circular movement of the arm.

The surface of the bones is covered with cartilages and tissues. Also, shoulder is surrounded by muscles and tendons. These structures provide mobility, stability and support to the shoulder joint.

A Shoulder Replacement Surgery is performed when a Shoulder Problem is not getting cured by non-surgical treatment options. In a Shoulder Replacement Surgery, the damaged parts of the shoulder are removed and replaced with artificial components called as prosthesis. The surgical options include replacement of just the head of the humerus (ball) or replacement of both the ball and socket (glenoid).

The goal of the Shoulder Replacement Surgery is to relieve shoulder pain and normalize shoulder functions and provide strength to the optimum. The procedure has a good success ratio and many patients return to active sports post this surgery.

Shoulder Replacement was pioneered by the French Surgeon Jules Emile Pean in 1893 who used platinum and rubber materials as implants. The procedure has greatly advanced over time and is now considered as the best option for patients with severe arthritic pain which is not relieved by non-surgical methods.

Conditions that require Shoulder Replacement in case non-surgical methods does not help, are as follows:

Osteoarthritis
Rheumatoid Arthritis
Severe Fractures
Rotator Cuff Tear Arthropathy
Post-traumatic Arthritis
Avascular Necrosis (Osteonecrosis)

Evaluation for Shoulder Replacement Surgery

A Shoulder Surgeon will do an evaluation based on the following:

    Medical History Physical Examination X-rays Other tests – in certain cases an MRI, blood test or a scan may be needed

Types of Shoulder Replacement

Based on your condition and severity of the problem, your doctor may recommend one of the following types of shoulder replacement surgery for you.

    1. Total Shoulder Replacement
    Here the total shoulder joint is replaced. The head of humerus bone is replaced by a highly polished metal bone with a stem and the glenoid is replaced with a plastic socket. Patients with severe arthritis and Rotator Cuff Tear Arthropathy are advised to undergo Total Shoulder Replacement

Shoulder Replacement showing the prosthesis

Shoulder Replacement

Shoulder Replacement X-Ray

    1. Stemmed Hemiarthroplasty
    In this case only the head of the humerus is replaced with a metal ball and stem. Patients who have arthritis only in the head of humerus or a severe fracture are generally recommended Stemmed Hemiarthroplasty.
    1. Resurfacing Hemiarthroplasty
    In this procedure, only the joint surface of the head of humerus is replaced with a cap-like prosthesis without a stem. Resurfacing Hemiarthroplasty is advised for Patient’s with no new fracture of the humeral head and in whom the glenoid still has an intact cartilage.
    1. Reverse Total Shoulder Replacement
    As the name indicates, in this procedure the ball and socket of the shoulder are reversed in position. A metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This reverse anatomy has some mechanical advantages for people with severe arthritis. Patients with completely torn rotator cuffs are recommended to undergo Reverse Total Shoulder Replacement Surgeries.

Complications

Patient’s generally don’t report any complications post surgery. However, as with any surgery Shoulder Replacement has the following complications in certain cases:

Infections:
Infections near the wound or near the prosthesis
Problems with Prosthesis:
There might be wear down in the prosthesis (very rare) and the components may loosen.
Nerve Injury:
Nerves in the vicinity of the joint replacement may be damaged during surgery (again very rare)

Rehabilitation Post-Surgery

Rehabilitation will include the following:

Taking rest for recommended duration
Wearing Sling for recommended duration
Medicines for managing pain
Physiotherapy
Restriction on some activities for recommended duration

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