SURGICAL SHOULDER REPLACEMENTS
Anatomic Shoulder Replacement
Anatomic shoulder replacement is indicated for patients with arthritis in the shoulder and when the rotator cuff muscles are intact or repairable. Anatomic shoulder replacement procedures can be divided into two types:
One procedure is a hemiarthroplasty. This occurs when the humeral head (ball) is replaced with a metal ball, but the glenoid (socket) is not replaced. This is performed in patients who only have arthritis in the humeral head (ball), and also in some select fractures of the humeral head in younger patients.
The other is an anatomic total shoulder replacement. In this case, in addition to the humeral head (ball) being replaced with a metal ball, the glenoid (socket) is also replaced with a medical-grade plastic component. Cement is used to attach the socket component in some shoulder replacement systems. Another option is called hybrid fixation, where in addition to using cement, a portion of the glenoid (socket) component has special metal where bone can grow into the component. The device placed in the upper humeral bone can be a stem or stemless implant. The metal humeral head (ball) is then attached to the stem or stemless implant.
Weight lifting restrictions for the anatomic total shoulder vary among surgeons. Many surgeons have a lifetime weight limit such as 25 pounds with the operative shoulder. Some patients whose recreational activities or occupations require a high weight limit may choose to have a hemiarthroplasty done where there are generally less restrictions.
Results and functional outcomes can vary between hemiarthroplasty and total anatomic replacement and it’s important to talk to your doctor to assess which option can best address your pain and motion. If you do heavy lifting, it’s important to have a discussion with your surgeon in regard to the specific limitations after an anatomic total shoulder replacement compared to a hemiarthroplasty.
Reverse Shoulder Replacement
Reverse shoulder replacement is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum.
A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm.
In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly.
In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. It essentially re-creates the function of the torn rotator cuff.
Reverse total shoulder replacement may be recommended if you have:
A completely torn rotator cuff that cannot be repaired
Cuff tear arthropathy
A previous shoulder replacement that was unsuccessful
Severe shoulder pain and difficulty lifting your arm away from your side or over your head
A complex fracture of the shoulder joint
A chronic shoulder dislocation
A tumor of the shoulder joint
Your doctor may also recommend surgery if nonsurgical treatments, such as rest, medications, cortisone injections, and/or physical therapy, have not relieved your shoulder pain.To learn more click here.
Partial Shoulder Replacement
Severe fractures, injuries, and conditions such as osteoarthritis and rheumatoid arthritis can break down shoulder cartilage causing pain, stiffness, and discomfort. If non-surgical treatments have failed to adequately address the pain, a partial shoulder replacement may be considered.
A partial shoulder replacement or stemmed hemiarthroplasty is a surgical procedure that may be used when only one portion of the shoulder has cartilage damage. The procedure replaces a segment of the joint (the ball) as opposed to its entirety. The diseased or injured area is removed and replaced with a new artificial surface.
There are several different options for performing this procedure, including minimally invasive arthroscopic surgery. We will discuss these options and determine the best treatment plan for you during a consultation about orthopaedic surgery.