Shoulder Replacement Surgery

Shoulder replacement surgery is indicated for people who have severe shoulder pain, shoulder immobility or grossly decreased range of movements from severe arthritis, or a shoulder fracture not correctable by other means.

Roughly around 23,000 US citizens undergo shoulder replacement surgery every year. Shoulder replacement surgery is an intricate procedure and can only be performed successfully by surgeons who have considerable experience in doing it. General anesthesia is used predominantly to do the procedure. The patient is discharged usually during the second or the third day after surgery.

Some of the diseases for which shoulder replacement surgery is done are:

1) Fractures of the shoulder
2) Rheumatoid arthritis
3) Arthritis following trauma
4) Degenerative shoulder joint disease (Osteoarthritis)
5) Avascular necrosis of the humeral head (becoming non viable due to loss of blood supply)
6) Arthropathy resulting from non correctable rotator cuff tear
7) Previous failed shoulder replacement surgery

The above diseases cause damage to the contact surface between the head of humerus and the glenoid cavity of the scapula, which results in destruction of the articular cartilage and pain. Patients also suffer from decreased range of mobility, making day-to-day activities very difficult, compromising the quality of living to a great extent.

Patients are carefully selected for shoulder replacement surgery. The aim is to provide pain relief and improved range of movement. Before surgery is done, each patient undergoes complete evaluation by anesthetist. People who are elderly, have hypertension, diabetes or had previous heart attacks also undergo a Cardiac evaluation. Aspirin, NSAIDS, other anti coagulant medications, which the patient might be taking, are stopped at least 2 weeks prior to surgery to avoid excessive bleeding during and after surgery.

As the shoulder is basically a ball and socket joint, inserting a highly polished metal ball replaces the head of the humerus, and a plastic socket is attached to the scapula. This arrangement replaces the arthritic humeral head and glenoid cavity of the scapula respectively.

While the metal ball component replacing the humeral head is a mandatory fitment in all shoulder replacement surgeries, the plastic socket replacing the glenoid component is optional. It is not needed in people with a good glenoid cavity (socket) with healthy cartilage.

The shoulder replacement surgery can be done with or without bone cement (poly methyl methacrylate). Bone cement is used when the humerus bone is soft and weak, while a strong humerus bone does not require bone cement to fix the prosthesis. But it is to be noted that bone cement is needed in most cases to fix the plastic glenoid cavity prosthesis wherever it is indicated.

Another type of shoulder replacement surgery called “reverse shoulder replacement surgery” is available. In this procedure, the metal ball is attached to the scapula and the socket is attached to the humerus. It is indicated in patients with completely torn rotator cuff tendons, severe arthropathy resulting from rotator cuff tear and in patients in whom previous conventional shoulder replacement surgery has failed. This procedure enables the patient to use his deltoid muscle to lift the arm instead of the rotator cuff muscles, thereby alleviating his pain and limitation of movements.