Total shoulder replacement is a great option for individuals who have failed conservative treatment for shoulder arthritis, chronic rotator cuff tears or have a severe fracture of the proximal humerus. Conservative options include anti-inflammatories, Tylenol, physical therapy, steroid (cortisone) injections, and passage of time. Shoulder replacements can be done as an outpatient procedure, or may spend one night in the hospital. Typical surgery time in the operating room is 2 hours. The surgical procedure requires the use of a general anesthetic, and usually a nerve block will be performed by the anesthesiologist prior to the procedure to minimize pain after the procedure.
There are two types of shoulder replacements.
The first is a standard total shoulder replacement. It is used for individuals who have severe shoulder arthritis and have an intact rotator cuff musculature. It has a stem that is inserted in the humerus and maintains the humeral head (ball) on the humerus. It also has a piece of plastic inserted into the socket (glenoid) that replaces the cartilage. It affords the most natural movement of the shoulder and gives great results for individuals looking to get out of pain.
The other type of shoulder replacement is called a reverse total shoulder. It is used for individuals who have severe arthritis that have a rotator cuff tear, or have had a fracture that is not repairable with standard plate and screw fixation. This surgery can dramatically improve the quality of life for individuals who have lost the function of their arm because of pain or weakness. It is called a reverse total shoulder because it “reverses” the ball and joint. The ball component is placed into the shoulder blade and the socket component is placed into the humerus. This reversal substitutes for the lack of rotator cuff function. Because of the design of the implant, it does restrict motion more than the standard total shoulder replacement. It is difficult for many individuals to reach behind their back. Though one gains the ability to reach overhead and perform important functional tasks.
Risks of surgery are rare but include infection, nerve or vessel injury, blood clots in arm or lung, dislocation of implants or tear of rotator cuff, anesthetic risks or medical complications of the anesthetic or nerve block. The benefits of total shoulder are great, and is an option worth considering. If you would like to discuss total shoulder replacement further, please call the office at 502-364-0902 and request an appointment with Dr. David Rhoads.