What’s New in Shoulder Replacement Surgery
Although much improvement has been made in the realm of shoulder replacement surgery over the last 30 years that has led to results similar to hip and knee replacements, there continues to be a push towards less invasive surgery with quicker recoveries and longer lasting excellent results.
Advances in anesthesia and smaller incisions have made it routine for shoulder replacement surgery to be performed on an outpatient basis where the patient goes home on the same day as surgery. Many patients prefer to recover and sleep in their own home, eating their own food, and being cared for by family members instead of nurses. A few hours after surgery, patients are able to eat solids and walk on their own. Family members are needed for the first 1-2 days to assist the patient in getting out of a chair, with dressing, and with food preparation.
Advances are also being made with the technology being used by surgeons. Computer navigation and GPS allows the surgeon to place the components more accurately with less need for bone resection. Although it will take years to see if these new techniques improve upon our current results, surgeons and engineers believe that more accurate positioning of the polyethylene and metal components combined with less bone resection will lead to even better results and longevity.
Shoulder Replacement Surgery: Total Shoulder Arthroplasty and Reverse Shoulder Arthroplasty
When arthritis affects the glenohumeral (ball and socket) joint, attempts are made to treat the pain non-operatively with a combination of medications, physical therapy and activity modification. When these modalities fail to relieve the pain, a shoulder replacement is performed. These are open procedures performed through a minimally-invasive approach. Fifty percent of patients go home the same day. Those patients who live alone often need to stay two nights. A sling may be worn for three weeks after surgery and physical therapy typically lasts three months.
A routine total shoulder replacement is performed when the rotator cuff muscles are intact. Designed to take away the pain from bone on bone arthritis, the procedure replaces the humeral head with a chrome ball attached to a titanium stem in the humerus. The glenoid is replaced with a polyethylene (medically grade plastic) socket. Cement is rarely needed on the humeral side but is always needed on the socket side. Pain relief and improved function is seen in 90% of patients who undergo this procedure, which is an excellent option to treat advanced arthritis of the shoulder joint.
A reverse shoulder replacement is used to treat arthritis in the setting of a torn or nonfunctioning rotator cuff. The rotator cuff tendons normally counteract the superior pull on the arm that the deltoid muscle provides. The rotator cuff tendons keep the humeral head centered on the glenoid socket. When the rotator cuff tendons are no longer working, the humeral head migrates superiorly because of the unopposed pull of the deltoid. The reverse shoulder replacement pushes the humerus down and puts the deltoid under tension.
The downsides of shoulder replacements are the same for all surgeries (infection, stiffness, persistent pain) with two new caveats. One is the fact that these artificial joints do not last forever. Patients are encouraged to avoid significant weight bearing with their new shoulder (avoid weight lifting and rock climbing) to make the components last. The other injury germane to any open surgery about the shoulder joint is injury to the nerves around the shoulder. Rarely injured during surgery, nerves are more at risk during revision surgery because they are encased in scar tissue that may need to be dissected. Nerve damage can present as muscle weakness and may take several weeks or months to improve.