Shoulder Replacement

Shoulder Replacement (Video Link - Shoulder Replacement)

Shoulder replacement is required when the shoulder joint is damaged beyond repair. There are two main reasons for this damage – one is severe fracture, breaking the ball of the shoulder into several pieces, and the other is damage as a result of arthritis.

Shoulder is a ball and socket joint. In cases of damage to the ball alone, replacing only the ball may be sufficient (hemi-arthroplasty). In cases where both, the ball and the socket are damaged, both may need to be replaced. There are cases of arthritis, where the surface of the ball is shaved off and replaced by a shell of steel (resurfacing).

Shoulder replacement is done via a 5 inch incision in front of the shoulder. After reaching the damaged ball and socket, the damaged ball is sawed off. The socket is cleaned with the help of special trimming tools called reamers. An artificial cup, made of plastic is fixed with the help of bone cement, on top of the patients damaged cup. Next the canal in the arm bone is opened and space created for taking the artificial ball which has a stem to fix it to the parent bone. The muscle around are re-sutured. With currently available techniques and implants, shoulder replacement is rivalling the success of knee replacement.

The most advanced version of shoulder replacement is what is called reverse shoulder replacement. In this, the ball and socket arrangement of the shoulder is reversed, that is, the ball is fixed on the cup side and the cup on the ball side. This type of shoulder replacement is meant for special situations where there is severe damage to the muscles around the shoulder as well. In such extreme shoulders ordinarily shoulder replacement would be unsuccessful.

What is shoulder replacement?

This essentially means changing the ball (humeral head) and socket (glenoid) of the shoulder joint.

When is it done?

It is done in osteoarthritis (loss of cartilage) of the shoulder joint alone or in association with a rotator cuff tear (rotator cuff arthropathy).

What are the types?

1. Resurfacing: This is the simplest of shoulder replacement, where the top of the ball (the head of the humerus) is reamed, and a steel cap is placed on it.  It works well in early stages of damage of the shoulder
2. Partial or only ball replacement: The ball part of the ball-and-socket joint is changed with an artificial ball made of steel. The cup remains original.
3. Total shoulder replacement: In this, both, the ball as well as the socket, are replaced. The ball is replaced with a metallic ball and the socket with a plastic socket. This is done conventionally in osteoarthritis of the shoulder with intact important shoulder muscles called rotator cuff muscles.
4. Reverse shoulder replacement: In this surgery also, the ball and socket, both, are changed.  But, they are placed in reverse position. This means the ball which is on the arm side is replaced by a socket, whereas the socket, which was on the other side is replaced by a ball. It is for this reason that it is called reverse shoulder replacement.  It is useful for advanced shoulder damage where even the deep muscles of the shoulder are damaged or torn.

How long does the surgery last?

The surgery lasts for about 2 hours.

What anaesthesia is given?

General anaesthesia with a block.

Is it painful?

Thanks to the latest anaesthesia techniques, like a block, pain relief is optimal.

How long do I have to stay in the hospital?

Conventionally 3-4 days is the average hospital stay.

What is the post-operative rehabilitation?

Immediately post op the patient is put on an arm pouch that is worn for 3-4 weeks and removed only during exercises.

The rehabilitation involves three phases

Phase 1: Gentle passive movements till the tissues around heal up (2-3 weeks)

Phase 2: Active and active assisted movements to regain movement (3-8 weeks)

Phase 3: Strengthening ( 8-12 weeks)

How successful is the surgery?

This is a very successful surgery with 95% surviving till 15 years.