When non-invasive treatments for shoulder pain have been exhausted, joint replacement is a highly successful option to relieve chronic joint pain. The shoulder joint is essentially comprised of a ball and socket. The ball, or the head of the upper arm bone (called the humerus), fits into the socket of the shoulder (called the glenoid). Both surfaces are covered in cartilage that allows for smooth motion. In addition, muscles surround the joint to provide strength and support for the shoulder’s high range of motion.
There are many conditions that can damage the muscles or one of the bones in the shoulder joint. These conditions can lead to extreme damage within the joint, causing pain that limits daily activity. Some of these include:
When shoulder pain associated with one of these conditions severely impairs your ability for a normal lifestyle, talk to your physician to determine if total shoulder replacement may be a good option. Because replacement surgery is not the solution for all shoulder pain, meeting with an orthopaedic surgeon, such as Dr. Urbanosky who specializes in shoulder replacement, is the best course of action.
Symptoms and Diagnosis
A physician specializing in shoulder conditions, such as Dr. Leah Urbanosky of Hinsdale Orthopaedics, will recommend an x-ray to help diagnose the source of pain. An x-ray of a shoulder that may need surgery might show:
These x-ray results will supplement a physical exam to check pain level, tenderness and range of motion of the shoulder joint.
A physician may recommend joint replacement surgery if anti-inflammatory medication, lifestyle accommodations, and physical therapy do not provide enough relief to combat the pain. When shoulder replacement surgery is performed, both the ball and socket portions of the joint are replaced. Typically, the ball and stem are made of polished metal, and the socket is plastic. These implants act as a substitution for the damaged or diseased joint. The stem implant is inserted into the arm bone, and the rounded ball headpiece fits into the shoulder socket. These implants are usually held in place with cement, though there are recent developments in which the implant is made with material that encourages bone growth over time.
This surgery is mostly done under full anesthesia, though this depends on your overall health.
Depending on your condition, your physician may recommend a reverse total replacement. In this procedure, the portions of the joint are reversed, so the socket is attached to the arm bone and the ball is attached to the shoulder. This is most commonly seen in patients who have suffered rotator cuff injuries or severe arthritis. This procedure allows the patient to use the arm muscle, as opposed to the rotator cuff, to move the arm.
Post-surgery, a patient will be given pain medication for several days. After a two to three day hospitalization, a sling is worn to allow the shoulder to heal. Therapy, which typically begins the day after surgery, is also necessary to return to day-to-day functioning. Therapeutic exercises are prescribed multiple times a day and gradually get more difficult as the joint is able to handle more activity. Most patients improve dramatically within two weeks of surgery, but returning to activities such as driving and sports can take longer. Six weeks is the average recommended amount of time for modified activity.
Courtesy of DePuy Orthopaedics, below are some PDFs for download that further explain total shoulder replacement.
Labral Tears (including SLAP tear)
Total Shoulder Replacement
Total Shoulder Replacement Animations
Advantage TSR (shown top)
Global TRS (shown bottom)