Most people are at least somewhat familiar with total knee replacements, even if you don’t understand the full scope of the procedure; but total shoulder replacements are not quite as publicized. Total shoulder replacements are a common procedure for shoulder ailments, but they are still far less common than total knee and total hip replacements.
Why does one undergo a total shoulder replacement? Often pain from arthritis spurs an individual to decide to have a total shoulder replacement, also known as a total shoulder arthroplasty (TSA). Osteoarthritis is also referred to a degenerative joint disease and results from gradual “wear and tear” on the joint from an accumulation of life’s activities. The cartilage that typically protects the ends of the bones wears away which results in “bone on bone” rubbing at the shoulder joint when the arm is moved. Arthritis can also develop in the shoulder from a traumatic injury like a fracture (broken bone) of the shoulder or arm, chronic rotator cuff injuries or weakness, or other injuries to the shoulder area that cause instability. These injuries can result in a loss of function and the need for a TSA in the future. Arthritis typically effects people around the age of 50, but can occur at a younger age especially if an injury occurred at the joint earlier in life. Rheumatoid arthritis is a different arthritic condition that causes chronic inflammation around the joint resulting in cartilage loss, pain, and stiffness. This condition usually presents itself earlier in life around the age of 30 and can also lead to the need for a TSA. Another condition that can also lead to joint damage and the need for a TSA is avascular necrosis. This condition occurs when the blood supply to the bone is disrupted resulting in degeneration of the joint. It can occur for a variety of reasons including chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use.
What does a total shoulder replacement entail? The extent of a total shoulder replacement can vary based on the amount of damage along the joint surfaces. The shoulder joint is what is called a ball and socket joint. The top of the humerus bone which is located along the upper arm forms the ball of the joint and the socket of the joint is what is called the glenoid. The glenoid is actually a portion of the shoulder blade that makes a shallow cup-like socket for the ball of the humerus to sit in. The ball, the socket, or both can be replaced by removing the damaged portion of the joint and replacing it with an artificial component called a prosthesis.
Is a shoulder replacement right for you? Conservative treatments like physical therapy for the shoulder should be attempted prior to undergoing a total shoulder replacement, because arthritis can often be managed with exercise programs and adjustments in form during various activities; but the condition can become severe enough that a TSA is the only option. Severe shoulder pain that interferes with daily function, moderate to severe pain at rest that disrupts sleep, loss of motion or weakness at the shoulder that effects function, and a failure to improve with conservative treatments like physical therapy, anti-inflammatory medications, or cortisone injections are all reasons to consider a total shoulder replacement. Individuals with depression, obesity, diabetes, Parkinson’s disease, multiple previous shoulder surgeries, shoulder joint infections, rotator cuff deficiency, and severely altered shoulder anatomy are not ideal candidates for the procedure. Individuals with rotator cuff deficiency may instead be candidates for a reverse total shoulder replacement. This procedure will be discussed more in depth in our next blog. Talk to your doctor or physical therapist if you feel that a TSA may be right for you.