Total Shoulder Replacement

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

When the cartilage is damaged, the two bones rub against each other resulting in pain, swelling and stiffness of the joint (osteoarthritis).

Total shoulder replacement surgery is performed to relieve these symptoms. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.

Indications

The presence of osteoarthritis, or rheumatoid arthritis are some of the most common causes of a person needing a total shoulder replacement. The doctor will have you try other means of treatment including medications, physical therapy, and changing your activities that could make the problem worse. If those solutions don’t offer enough relief, the next step may be to consider the surgical procedure. If the pain is chronic, you have limited range of motion, and you find it hard to take part in daily tasks then you will likely be referred for surgery.  To recap, symptoms include:

  • Severe shoulder pain that restricts daily activities
  • Moderate to severe pain during rest
  • Weakness and/or loss of motion

Diagnosis

To decide whether total shoulder replacement is a good option for you the surgeon will evaluate your condition thoroughly.

An exam and testing has to be conducted to determine the underlying causes of your shoulder pain. This is also to determine if you are a good candidate for the total shoulder surgery procedure. Your medical history, x-ray, and an MRI may be required to determine what is taking place and to identify the best treatment.

Procedure

The surgery is done under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.

The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem, is gently press fit into the humerus.

Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone. After the artificial components are implanted, the joint capsule is stitched and the wound is closed.

Post-operative Care

It is very important to follow all of the directions of your doctor after a total shoulder replacement. This will help to reduce the risk of infection and to help it heal correctly. You may be given medication to reduce inflammation and to reduce pain. Antibiotics may be given to prevent an infection. You may need to immobilize your shoulder in a sling for a few weeks.

Physical therapy will be started in the days after the surgery to help get the shoulder stronger and to improve range of motion. You will likely be on limited activity for about six weeks. Your doctor can discuss this with you further at your follow up appointment once they see how well the healing has progressed.

Risk and Complications

As with any major surgery, there may be potential risks involved:

  • Anesthetic complications such as nausea, dizziness and vomiting
  • Infection of the wound
  • Dislocation, requiring repeat surgery
  • Damage to blood vessels, nerves or muscles
  • Failure to relieve pain
  • Pulmonary embolism
  • Wear and tear of prosthesis

    Proudly serving patients across New Jersey and Bergen County from our office in Hackensack. Whether you are in Jersey City, Rutherford, Garfield, Lodi, Ridgewood, Nutley, or Englewood, NJ, we look forward to addressing your questions and providing you with the treatment you need.

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