Total Shoulder Replacement is similar in concept to total knee replacement and total hip replacement. When arthritis has damaged or destroyed the shoulder joint, it may be replaced with a metal ball and plastic socket. Although there are many different types of shoulder replacements, the concept remains that the damaged surfaces of the bone are replaced.
Shoulder replacements have been performed since the 1950's, and although fewer are done than compared to hip and knee replacements, their life span typically outlasts joint replacements of the lower extremities. The surgical procedure is generally considered more difficult and complex, and the rehabilitation program is prolonged. However, with a well done procedure, a motivated patient can return to activities such as golf, swimming and tennis with little difficulty.
Total shoulder replacement is most frequently considered for patients who have either osteoarthritis or rheumatoid arthritis. A physician should exhaust all reasonable non-surgical alternatives of management before contemplating a joint replacement. Trials of activity modification, gentle physical therapy to maintain muscle tone, anti-inflammatory medication and occasional pain medication may be sufficient to make symptoms tolerable. If, however, pain and disability cannot be managed with a non-operative program, total shoulder replacement can provide remarkable relief pain and allow much improvement in activity. This procedure should nearly always be considered elective; only very rarely is it absolutely necessary. Some patients may sustain severe trauma with fracture of their shoulder, and in those situations, replacement of the shoulder with an artificial joint becomes the only reasonable option.
Under regional or general anesthesia, the shoulder area is surgically approached through a 6" incision on the front of the shoulder. After dividing only one muscle, the diseased joint is entered. The arthritic bone is resected from the humerus (upper arm bone). The socket of the shoulder is prepared and a plastic liner is cemented in place in a similar fashion to placing a filling on a tooth. A metal ball with a stem is placed down the arm bone in such a way that cement is usually not required. The surface of the prosthesis has a special coating which allows human bone to grow into it, thereby providing fixation without the need for cement. The rotator cuff muscles are repaired, and the wound is closed. The entire procedure takes about 2-1/2 hours.
The arm is placed in an immobilizer for 24 hours. The morning following the procedure, the immobilizer is removed and the patients are encouraged to use their arms immediately for simple tasks such as feeding, brushing teeth, etc. The first 8 weeks are devoted to home exercises that improve motion. Subsequently, home therapy is performed to strengthen muscles. Nearly all patients perform their own therapy at home twice a day for no more than 5 minutes. Only rarely is there a need for outpatient therapy interaction. Activities such as golf may resume in as little as 6 weeks.