Shoulder Replacement

Whether you're pitching a ball, doing some heavy lifting on the job or just getting something out of the refrigerator, the ability to move your shoulders is vital to performing day-to-day activities -- but what if accomplishing even the most basic physical tasks is a challenge?

Stiffness or pain in your shoulder can have several causes that can lead to treatment plans such as shoulder replacement. A healthy shoulder should consist of articular cartilage between the ball of the humerus (upper arm bone) and socket of the scapula (shoulder blade bone). The smooth articular cartilage protects the bones from friction and increases range of motion. Prolonged breakdown of the articular cartilage can cause damage to the ball-and-socket joint and result in severe discomfort.

Treatment plans can vary depending on your diagnosis. For people who don’t feel relief from non-surgical treatment options, shoulder replacement surgery is recommended to help restore movement and reduce pain for patients suffering from shoulder arthritis.

What is Shoulder Replacement Surgery?

Shoulder replacement surgery (shoulder arthroplasty) is a procedure that involves removing and replacing damaged parts of the bones of that shoulder with artificial implants.

When medication and physical therapy are no longer effective, shoulder replacement surgery is a common and successful treatment for patients suffering from severe shoulder pain or restricted movement.

Shoulder replacement therapy can benefit people who suffer from:

Severe Shoulder Osteoarthritis
Rotator Cuff Tear Arthropathy
Rheumatoid Arthritis
Severe Fractures

Generally, there are two types of shoulder replacement treatment plans that are implemented to restore range of motion and reduce pain: total shoulder replacement and reverse shoulder replacement.

Total Shoulder Replacement Therapy

Over the last 50 years the most common type of shoulder replacement therapy has been total shoulder replacement.¹ During total shoulder replacement, your orthopedic surgeon replaces the shoulder's ball-and-socket design with a three-dimensional prosthetic that mimics the natural shape of the shoulder. A metal ball and plastic socket are placed exactly where the natural shoulder bones are located.

Good candidates for total shoulder replacement surgery typically have bone-on-bone shoulder osteoarthritis and no or minimal damage to their rotator cuff muscles. The Catalyst Archer CSR is a more contemporary, less intrusive type of shoulder replacement.

Reverse Shoulder Replacement

Similar to total shoulder replacement, reverse shoulder replacement helps treat chronic shoulder pain by using uniquely designed implants to replace damaged parts of the shoulder.

The major difference in the two procedures is the shape of the implants. In total shoulder replacement, the implant is positioned where the humerus and scapula socket meet. In reverse shoulder replacement, the implants are designed so that the socket implant is placed at the head of the humerus while the ball implant is positioned in the rounded socket of the scapula.

Reverse shoulder replacement is the preferred method of treatment for patients with damage to their rotator cuffs or complications with previous total shoulder replacement surgeries.²

Who Needs Shoulder Replacement?

The type of shoulder pain treatment plan a patient receives varies from person to person. Factors like age, physical activity level, pain, and medical history are all taken into account by physicians when deciding paths to treatment.

Shoulder replacement therapy is considered the best option for patients with chronic shoulder joint issues who are not responding to non-invasive treatment options. With low rates of complication and high rates of success, shoulder replacement surgery has become the gold standard in orthopedic medicine when treating chronic shoulder conditions like arthritis and rotator cuff arthropathy.³

Osteoarthritis

Shoulder osteoarthritis is a type of arthritis that is caused by wear-and-tear of soft tissue and joint cartilage in the shoulder. As, the cartilage breaks down, the friction increases in the joint and pain and mobility issues begin to appear. Shoulder osteoarthritis is classified as either primary or secondary.

Primary osteoarthritis is generally related to age, sex, and genetic components. Women and people over the age of 50 are typically at higher risk to this type of shoulder arthritis.
Secondary osteoarthritis has a specific trigger or cause such as previous dislocations, injuries, or rotator cuff tears.

A good candidate for total shoulder replacement surgery typically suffers from shoulder osteoarthritis with an intact rotator cuff and reports symptoms such as:⁴

Moderate to severe pain when sleeping or performing any kind of physical activity
Lack of range of motion or mobility when performing routine activities
No response to noninvasive treatment options

Rotator Cuff

The rotator cuff is made up of four muscles that hold the shoulder in place, and assist with smooth movement of the shoulder. When the rotator cuff is damaged or injured, severely degenerative joint diseases can develop. Risk factors for rotator cuff tears include:

Aging
Intense physical activity
Falling or injuring the shoulder in an accident
Overusing the shoulder

Rotator cuff injuries are usually manageable with physical therapy. However, prolonged breakdown of the rotator cuff typically does not resolve on its own and may develop into rotator cuff tear arthropathy. Rotator cuff arthropathy is a specific type of shoulder arthritis that causes degeneration of the rotator cuff muscles and cartilage surrounding the shoulder joints.

In severe cases, reverse shoulder replacement surgery can benefit patients with rotator cuff arthropathy. In fact, reverse shoulder replacement surgery was created specifically for people who suffer from this degenerative joint disease.⁵ Even with implants, traditional shoulder replacement is not helpful in these cases because the rotator cuff tendons are still unable to move properly.

Reverse shoulder replacement addresses this issue by allowing the shoulder to rely on the deltoid muscles instead of the damaged rotator cuff, thus bypassing the rotator cuff muscles that are usable to be repaired or restored.

What is causing my shoulder condition?

The symptoms of rotator cuff arthropathy can be very similar to shoulder osteoarthritis caused by other factors. To determine the source of your shoulder pain or stiffness, talk to your orthopedic doctor. Your physician will ask you specific questions and order x-rays to evaluate the source of your joint condition. With a full picture, your doctor can take you through your treatment options.

Successful Shoulder Replacement

Like any major surgical procedure, shoulder replacement surgery can be taxing on the body and requires aftercare and rest to ensure maximum success.

The good news is that over 95% of patients who undergo shoulder replacement surgery reported being pain-free 1 year postoperative care.⁶

Most patients do experience some pain early on which subsides overtime with the help of physical therapy and pain medications provided by their orthopedic surgeon.

Recovery Time

Total Shoulder Replacement is typically done with an overnight stay, however same day discharge or outpatient shoulder replacement has been shown to be safe in appropriate patients and is becoming increasingly more common. Along with pain medication, your doctor will put you on a rehabilitation regimen to make sure your recovery goes smoothly.

Once discharged, you will be sent home with an arm sling that you should wear for 2-4 weeks. Even though your arm will be in a sling, many basic functions can still be accomplished with the operative arm.

Shoulder and arm functioning will be limited for at least 6 weeks, so make sure you discuss with your surgeon your specific restrictions. These are standard surgical guidelines, however, different surgeons have different protocols after surgery.

Physical Therapy

Although your arm will be in a sling after surgery, it can be taken off to do physical therapy exercises. Physical Therapy is an important part of the recovery process and usually begins shortly after your shoulder replacement surgery.⁷

After evaluation, your physical therapist will generally provide you with an at-home exercise program that may consist of:

Ice pack therapy to keep pain at a minimum
Function-specific exercises
Range of motion stretches
Resistance exercises
Massages to manage scar tissue buildup

Be sure to complete your physical therapy regimen. Carefully following aftercare instructions will get you back to the physical activities you love in no time!