Shoulder Arthroplasty:
How common is shoulder arthritis?
Arthritis of the shoulder ("glenohumeral joint") is relatively rare compared to other joints such as the hip or knee. Part of the reason for this is that most people do not bear weight on their shoulder joints. Sometimes arthritis is secondary to old injuries (fractures, dislocations) or untreated rotator cuff tears.
What can be done for arthritis?
Because you do not walk on your shoulder, arthritis in this joint can often be tolerated pretty well. Sometimes, however the pain can be excrutiating when using the arms, or sleeping on the affected side at night. As the arthritis progresses, the shoulder motion becomes more and more limited.
Our first step is treatment with anti-inflammatory medications. Recently, nutritional supplements called glucosamine and chondroitin sulfate (available over-the-counter at any pharmacy) have been shown to be of benefit in treating arthritis. Often injections of steroids into the joint and physical therapy can be of benefit. Some patients will respond well to an arthroscopy with debridement of loose pieces of cartilage and bone. Finally, if none of these things seemed to work, then we will recommend a shoulder replacement - called "arthroplasty".
What do you replace the shoulder with?
We replace the humeral head with a metal ball that is attached to a stem placed into the middle of your humerus. If this is all that is done, we call this a "hemiarthroplasty". If we replace the cup of the shoulder joint - the glenoid - with a plastic material, then we call the procedure a "total shoulder arthroplasty".
How does one decide between a hemiarthroplasty and total shoulder?
For most patients with osteoarthritis, hemiarthroplasty is the preferred procedure. Although total shoulders can make you feel better by replacing both sides of the joint, instead of one, they have more complications in the long run. These primarily include loosening of the glenoid component and a higher risk for dislocation.
Some patients may need to have a total shoulder, however. These include patients who have had significant destruction of their glenoid cartilage or patients with rheumatoid arthritis.
How long does the procedure take?
Surgery usually takes 1.5 - 2.5 hours, depending on what needs to be done. The patients typically spend a night or two in the hospital afterwards for control of pain.
What can I expect from surgery?
You can expect to have a significant relief of pain in your shoulder. Sometimes, we are able to increase the range of motion by surgery - however, this usually does not improve as much as your pain does. Therefore, you should select the surgery for relief of pain, primarily, not improvement of motion.
What does the rehabilitation entail?
I encourage my patients to move their shoulders immediately after surgery. In some directions, you will be able to move your arm using your own strength. In others, we will start with passive motion only - this means that you use the other arm to move your shoulder - not the muscles in your shoulder. We had to cut through certain muscles and re-attach them at surgery - we don't want you to use those muscles until the they have healed. You will follow a specific rehabilitaton program, typically with a physical therapist. This often lasts around 2-3 months, depending on the patient.
- Dr. Laith Farjo, M.D.
Telephone:
(810) 299-8550