Total Shoulder Replacement

Total shoulder replacement, also known as total shoulder arthroplasty, is a surgical procedure where the damaged or arthritic joint surfaces of the shoulder are replaced with artificial components. The goal of the surgery is to alleviate pain, restore mobility, and improve function in the shoulder joint.

Indications for Total Shoulder Replacement

• Osteoarthritis: wear and tear of the joint cartilage and bone
• Rheumatoid arthritis: an autoimmune disease that causes inflammation and damage to the joints
• Post-traumatic arthritis: arthritis that develops after a shoulder injury or fracture
• Avascular necrosis: death of bone tissue due to lack of blood supply
• Rotator cuff arthropathy: arthritis that develops in conjunction with a rotator cuff tear

Components of Total Shoulder Replacement

The total shoulder replacement prosthesis consists of three main components:

• Humeral head component: a metal ball that replaces the natural humeral head
• Glenoid component: a plastic or metal tray that replaces the natural glenoid socket
• Stem component: a metal rod that is inserted into the humerus to secure the humeral head component

Surgical Procedure

The surgical procedure for total shoulder replacement typically involves the following steps:

1. Administration of anesthesia: general or regional anesthesia is used to numb the area and ensure patient comfort during the procedure
2. Incision: a 3-4 inch incision is made in the front of the shoulder to access the joint
3. Dislocation: the humerus is gently dislocated from the glenoid socket to allow for component placement
4. Component placement: the humeral head, glenoid, and stem components are inserted and secured with bone cement or screws
5. Closure: the incision is closed with sutures or staples, and a dressing is applied to protect the wound

Recovery and Rehabilitation

After total shoulder replacement surgery, patients typically undergo a rehabilitation program that includes:

• Pain management: medication and ice are used to manage pain and discomfort
• Immobilization: the arm is immobilized in a sling or brace for several weeks to allow for healing
• Physical therapy: exercises and stretches are performed to improve range of motion, strength, and function
• Follow-up care: regular follow-up appointments with the surgeon are necessary to monitor progress and remove sutures or staples

Risks and Complications

As with any surgical procedure, total shoulder replacement carries risks and potential complications, including:

• Infection: bacterial or other infections can occur at the wound site or in the joint
• Bleeding: excessive bleeding during or after surgery can lead to hematoma or anemia
• Nerve damage: injury to surrounding nerves can cause numbness, tingling, or weakness
• Prosthesis failure: loosening or wear of the artificial components can require revision surgery

Outcomes and Expectations

Total shoulder replacement can provide significant pain relief and improved function for patients with severe shoulder arthritis. Most patients are able to:

• Regain range of motion: improve flexibility and mobility in the shoulder joint
• Reduce pain: alleviate chronic pain and discomfort associated with arthritis
• Improve strength: increase muscle strength and endurance in the shoulder and surrounding muscles
• Return to activities: resume daily activities, sports, or hobbies with improved function and reduced pain

The longevity of the prosthesis can vary depending on factors such as age, activity level, and overall health. On average, a total shoulder replacement prosthesis can last for 10-20 years before requiring revision surgery.