Shoulder replacement would be considered when a person has long term and degenerative arthritis of the shoulder. Otherwise known as osteoarthritis, this progressive degeneration of shoulder joints occurs when the protective surface (cartilage) that allows the joint to move smoothly is damaged. Over time, this cartilage is worn away and the underlying bones become exposed. The humeral head (ball) now rubs painfully against the glenoid (socket) and the joint becomes increasingly abnormal. The outcome? Pain and stiffness.
Signs you could need a shoulder replacement
And that’s exactly what I hear from patients who see me with this condition. These people typically complain of a stiff and painful shoulder that has a limited range of movement.
I frequently have patients who see me with this condition tell me their pain and stiffness intensifies when they use or move their shoulder. They also describe a “catching” and “noise”, something I can verify on examination.
Painful interruption of sleep is another inconvenient bi-product of this debilitating condition. Together, these factors contribute to a person feeling negative, and even depressed, as their mobility diminishes and their mental and emotional wellbeing is impacted.
While the pain and discomfort is the major contributor to this less than optimistic outlook, I also see the uncertainty caused by not knowing what the future holds causing patients to feel the future for their shoulder is bleak.
When I treat people with osteoarthritis in their shoulder, I will always consider the full range of options. I make my diagnosis using a combination of clinical examination and reviewing the history of the individual’s condition.
Before considering any treatment, we review x-rays that help evaluate the extent of any damage. It might also be necessary to obtain a CT scan of the shoulder, as this is helpful in deciding whether surgery is appropriate.
I need shoulder replacement surgery. Are there different types of shoulder replacements to choose from?
In cases where pain is severe, or in previous failed treatment options, shoulder replacement could be the best next step to living without pain. The ideal surgery option for you will be determined by many factors, including your age, activity level, form of arthritis, the amount of bone affected, and even your surgeon’s preference.
In the past, there have been three forms of shoulder replacement used:
Hemiarthroplasty, in which a prosthetic metal and now ceramic implant is placed into the upper bone of the arm (the humerus – the ball).
Total shoulder arthroplasty, involving replacement of both sides of the joint, ball and socket.
Reverse shoulder replacement, which entails a specific design used for the replacement, depending on the person’s pattern of arthritis.
I’m a specialist in all forms of shoulder replacement. Having trained in this type of surgery with some of the world leaders from the Boston Shoulder Institute, I’ve learned and been practising the best and most advanced techniques for this procedure. The choice of shoulder replacement performed is a technical one, and best left to your surgeon.
These practices entail planning and performing a patient’s surgery using 3D computer planning software, using the patient’s own replacement requirements. Effectively, this allows me to perform the operation before I physically do it. This planning means accuracy of the procedure is significantly higher because the replacement shoulder is placed millimetre perfect to the ideal position for each person. It also means there are fewer complications and the time a patient is under anaesthetic is reduced.
What are the treatment options for osteoarthritis?
Remembering shoulder replacement surgery is just one option on scale of treatments, so let’s also look at other treatment options:
- Physiotherapy – Physiotherapy is worth considering for its value in being able to prevent any further stiffness and to help regain a range of motion. Your surgeon would refer you to a physiotherapist they trust. The benefit of this approach is that to a large degree, management is in your hands.
- Pain relief and anti-inflammatory medication – To be considered within a broader treatment plan, pain relief and anti-inflammatory medication is helpful for providing relief of symptoms. In no way curative, these drugs are not a long term solution for fixing the osteoarthritic condition.
- Steroid injections – Again, not a long term solution, steroid injections can be given to provide short term pain relief. Be aware the effectiveness of steroid injections is unpredictable due to the wide variability in presentation of osteoarthritis in patients and they should not be repeatedly as they have been shown to cause further damage to the joint.
- Surgery – Now within surgery, there are levels of intensity on a scale from least invasive to full shoulder replacement (arthroplasty), so it’s worth covering these in more detail here.
The least invasive form of surgery is arthroscopic treatment of the shoulder, which is essentially a “tidy up” of the joint. In this procedure, the surgeon removes unwanted loose material and smoothes off the joint, a process which is intended to provide relief of symptoms.
Two things you should know about arthroscopic treatment is that it is typically prescribed for a younger patient and it has a shelf life. By that I mean, at some point, a shoulder replacement will be required. If that’s you, then read on.