Shoulder Replacement Surgery
The shoulder joint consists of a shoulder blade (scapula) and an arm bone (humerus).
This joint is what is known as a ball (head of the humerus) and socket (glenoid fossa of the scapula) joint. In a healthy shoulder, the surfaces of the ball and socket are covered in cartilage. The cartilage acts as a protective barrier to the bones that touch each other allowing for smooth, pain-free motion.
Due to arthritis or injury, this cartilage sometimes becomes worn and no longer provides the protection needed to pad the joint. This results in painful movement and decreased functional use of the arm. In some cases, conservative treatments, such as medications and modifications of daily activities, no longer provide adequate pain relief. Then, a total shoulder replacement may become the best form of treatment to regain pain-free motion and functional use of the arm.
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components. There are several shoulder replacement options, which include the following:
Total shoulder replacement surgery
The typical total shoulder replacement surgery involves removing the damaged part of the joint and replacing it with artificial parts (metal and polyethylene). In order to do this, the surgeon needs to cut through the front part of your rotator cuff to gain access to the shoulder joint. The surgeon replaces the glenoid fossa (socket) and the head of the humerus (ball) with new implants. Then, the rotator cuff is repaired to regain stability of the shoulder joint.
Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
Hemiarthroplasty is a procedure in which one half of the joint is replaced with an artificial surface. The other part is left in its natural state. Your surgeon may choose this option and replace only the ball of the shoulder. A stemmed hemiarthroplasty is a procedure in which the head of the humerus is replaced with a metal ball and stem, much like the component used in a total shoulder replacement.
Hemiarthroplasty is sometimes recommended for:
- Shoulders in which the head of the humerus is severely fractured but the socket is normal.
- An arthritic shoulder with a damaged humerus but a healthy socket with an intact cartilage surface.
Reverse total shoulder replacement surgery
A reverse shoulder replacement surgery is used to treat patients with severe arthritic damage along with large retracted rotator cuff tears. This procedure is the opposite of a traditional shoulder replacement. It involves inserting a metal ball section to the glenoid (socket) instead of the humerus. The normal head of the humerus (ball) is replaced with an implant that has a socket. The artificial ball rests in this artificial socket. This method allows the arm to be moved primarily by the deltoid muscle instead of the rotator cuff.
Stemless shoulder replacement
A stemless shoulder replacement offers more active patients an additional surgical option for shoulder pain caused by arthritis. This procedure falls between traditional total shoulder replacement and resurfacing shoulder implants. It involves the attachment of an implant to the head of the humerus (ball) without going into the diaphysis (shaft) of the bone. This process allows the surgeon to position the implant without complications from the shape of the shaft. It also preserves the humeral bone shaft in the event that any revision surgery is needed in the future.