Total Shoulder Replacement Arthroplasty is a very well established surgical procedure for restoring comfort & function in patients with arthritic shoulders. Arthritic ball is replaced by a smooth metallic ball which is fixed to humerus (arm bone) by a stem which fits in it during this procedure. Arthritic glenoid (socket) is also resurfaced as part of this procedure with high-density polyethylene prosthesis. Among different types of surgical options which are available for arthritis shoulders, this procedure seems to provide the most rapid & complete improvement & which is comfortable & functional for patients with arthritis in shoulders. Success will however require technical excellence of surgery & patient's commitment to exercise program until desired range of motion can be comfortably achieved.
Key Parts of the Normal Shoulder Joint
Humeral head or the ball fits within the socket called glenoid & which is held there by the rotator cuff.
What is Shoulder Arthritis?
Arthritis of the shoulder is a condition where previous surgery, inflammation, injury or degeneration destroys the normally smooth cartilage lining the ball (humeral head) & the socket (glenoid).
Diagnosing Shoulder Arthritis
Carefully standardized x-rays generally reveal loss of space between glenoid & the humeral head, which is normally occupied by cartilage, leaving bone upon bone contact.
Total Shoulder Replacement Arthroplasty Procedure
In a total shoulder replacement arthroplasty procedure, the arthritic ball is replaced with a metal ball along with a stem which is press fit inside the humerus or arm bone so that only the smooth surface is extending from the bone. The socket which takes in this ball is also resurfaced with high density polyethylene component. This operation is usually performed under influence of a regional or general anesthetic. Approach to the joint is made possible through an incision made between the pectoralis major muscles & deltoid on the front of the shoulder. This also includes release of contractures & adhesions along with removal of bone spurs which may be blocking range of motion. For this operation, services of an operating team are required, which includes anesthesiologists, orthopedic surgeons & surgical assistants who normally perform this operation in less than two hours of time.
- Fixing the Humeral Component in Humerus
While there are some surgeons who prefer cementing the humeral component, others use implants which foster bone growth along the stem. Both these approaches can eventually stiffen the bone in order to make it more likely to fracture in a fall & also greatly complicating revision surgery in case that may become necessary in future. In order to overcome these issues, some surgeons prefer fixing the component by impaction grafting inside humerus by using healthy bone, which is recently harvested during the procedure from humeral head which was removed, until a tight press fit of implant is achieved.
- Fixing the Glenoid Component to Glenoid Bone
Bone of glenoid is precisely shaped with glenoid reamer & then the glenoid component is secured with a combination of cementing & press fitting. Patients must however maintain range of motion achieved during surgery with simple & frequent stretching exercises in order to promote proper healing of the replaced shoulder joint. Exercises for rehabilitation are started immediately following surgery by using continuous stretching & passive motion by the patient. Attaining & maintaining a minimum of 150 degrees of forward elevation is critical to success of total shoulder replacement surgery. Supine stretch & forward lean can be very helpful in attaining these results & maintaining the range of motion which is attained.
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