Total Shoulder Arthroplasty

Total shoulder arthroplasty (TSA) is a surgical procedure where the damaged or arthritic joint surfaces of the shoulder are replaced with artificial components. The goal of TSA is to alleviate pain, restore mobility, and improve function in patients with severe shoulder arthritis or other degenerative conditions.

Indications

TSA is typically indicated for patients with:

• Severe osteoarthritis of the shoulder joint
• Rheumatoid arthritis
• Avascular necrosis (death of bone tissue due to lack of blood supply)
• Fractures or trauma that have resulted in severe joint damage
• Failed previous shoulder surgeries

Surgical Procedure

The TSA procedure involves the following steps:

1. The patient is placed under general anesthesia and positioned in a beach chair or lateral decubitus position.
2. An incision is made in the front of the shoulder, typically around 4-6 inches long.
3. The deltoid muscle and other surrounding tissues are carefully dissected to expose the joint.
4. The humeral head (ball) and glenoid (socket) are removed and replaced with prosthetic components made of metal, ceramic, or plastic materials.
5. The humeral component is typically a stemmed implant that is inserted into the humerus (upper arm bone), while the glenoid component is a cup-like structure that is attached to the scapula (shoulder blade).
6. The prosthetic components are secured in place using cement or press-fit techniques.
7. The surrounding tissues and muscles are then repaired, and the incision is closed.

Types of TSA

There are several types of TSA procedures, including:

• Anatomic TSA: This involves replacing the humeral head and glenoid with prosthetic components that mimic the natural anatomy of the joint.
• Reverse TSA: This involves reversing the position of the ball and socket, where the ball is attached to the scapula and the socket is attached to the humerus. This type of procedure is often used for patients with severe rotator cuff tears or other complex shoulder conditions.

Risks and Complications

As with any surgical procedure, TSA carries certain risks and complications, including:

• Infection
• Bleeding or hematoma
• Nerve damage or numbness
• Prosthetic loosening or wear
• Dislocation or instability of the joint

Recovery and Rehabilitation

After TSA, patients typically require several months of rehabilitation to regain strength, mobility, and function in the shoulder. The recovery process involves:

• Pain management with medication and physical therapy
• Gradual range-of-motion exercises to improve flexibility and mobility
• Strengthening exercises to build muscle mass and stability around the joint
• Activity modification to avoid heavy lifting, bending, or overhead activities

Outcomes and Expectations

The outcomes of TSA can vary depending on individual factors, such as the severity of the condition, overall health, and adherence to rehabilitation protocols. However, in general, patients can expect:

• Significant reduction in pain and improvement in function
• Improved range of motion and mobility
• Enhanced quality of life and ability to perform daily activities
• A durable and long-lasting prosthetic joint, with an average lifespan of 10-20 years or more