SHOULDER REPLACEMENT

Total Shoulder Replacement

Total shoulder replacement, also known as total shoulder arthroplasty (TSA), is a tremendously successful procedure for treating the severe pain and stiffness that often result at the end stage of various forms of arthritis or degenerative joint disease of the shoulder joint. The primary goal of shoulder replacement surgery is pain relief, with a secondary benefit of restoring motion, strength, function, and assisting with returning patients to an activity level as near to normal as possible. Many patients return to the sports they love like tennis, golf, and swimming, while also pursuing personal health initiatives such as individual training, yoga and pilates.

Painful shoulder arthritis refers to the disappearing of the normally smooth cartilage surfaces of the shoulder, which permit the ball and socket to smoothly glide against one another. This disappearance of cartilage covering results in a “bone on bone” joint and can be quite painful. Thus new surfaces provide the answer for the restoration of comfort.

Many a times patient who has large rotator cuff tear develops the disease called rotator cuff arthropathy. In this patient, this conventional Total Shoulder Arthroplasty can’t give satisfactory results. For all such patients “Reverse shoulder arthroplasty” is a better option.

Reverse Shoulder Replacement

In conventional shoulder replacement, we try to mimic the normal anatomy of the shoulder. Thus a cup is fitted on to the glenoid (the socket) and the metallic ball is fitted on the saddle joint a plastic “cup” is fitted into the shoulder socket (glenoid), and a metal “ball” is attached to the top of the upper arm bone (humerus).

In a reverse humerus end total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus.

Normally function of the shoulder joint relies on two groups of muscles Deltoid and another is Rotator Cuff. These two groups have different and opposite actions. Both these groups act synergistically to stabilize and optimize the shoulder joint function and movements.

Rotator cuff helps to stabilize the humeral head in the socket so whenever the rotator cuff is torn or deficient the humeral head migrate upward leading to dysfunction. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function.

A reverse total shoulder replacement works better for people with cuff tear arthropathy because it doesn’t rely on rotator cuff to move the arm. It relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.

shoulder (Left) Rotator cuff arthropathy. (Right) The reverse total shoulder replacement allows other muscles such as the deltoid to do the work of the damaged rotator cuff tendons.

This surgery was originally designed in the 1980s in Europe. The Food and Drug Administration (FDA) approved its use in the United States in 2003.

Indications

Reverse total shoulder replacement may be recommended if you have:

Rotator Cuff tear arthropathy.
Severe shoulder pain and difficulty lifting your arm away from your side or over your head.
A complex fracture of the shoulder joint.
Tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain.

Surgery

The components of a reverse total shoulder replacement include the metal ball that is screwed into the shoulder socket, and the plastic cup that is secured into the upper arm bone.

This procedure to replace your shoulder joint with an artificial device usually takes about 2 hours.

Incision is taken either on the front or the top of your shoulder. We remove the damaged bone and then position the new components to restore function to your shoulder.

Surgical Complications:

Reverse total shoulder replacement is a highly technical procedure. Your surgeon will evaluate your particular situation carefully and discuss the risks of surgery with you.

Risks for any surgery include bleeding, nerve damage, and infection. Complications specific to a total joint replacement include wear, loosening, or dislocation of the components. If any of these occur, the new shoulder joint may need to be revised, or re-operated on.

Do's and Dont's After Surgery :

Do follow the home exercise program prescribed by your doctor.
Don’t lift anything heavier than 5 lbs. for the first 6 weeks after surgery.
Don’t push yourself up out of a chair or bed, as this requires forceful muscle contractions.