Shoulder Arthritis
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. Biologic therapy, such as platelet rich plasma or cellular based therapies can often help with pain. 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?
Shoulder replacements involve replacing the shoulder with metal, as well as usually plastic pieces (ultra-high molecular weight polyethylene). There are 3 different types of shoulder replacements:
- Shouder hemi-arthroplasty or resurfacing arthroplasty. This is the only type of replacement that does not involve using any plastic components in the joint. It is used in specific situations, when there is only arthritis on the humeral (ball) side of the joint and not the glenoid (socket) side. The advantages of this include no plastic to potentially wear out. The disadvantage is that if the glenoid socket eventually wears out, the prosthesis will need to be revised.
- Anatomic total shoulder arthroplasty (aTSA). This involves placing a metal stem in the humerus and a plastic (polyethylene) spacer on the glenoid socket. This is the “traditional” total shoulder replacement. The advantage of this is that it will feel a little more like your “normal” shoulder (i.e. which you haven’t felt in years). The disadvantage is that the plastic is prone to wearing out and may need to be revised in the future. Furthermore, the shoulder is more prone to dislocations than the other two types of replacement. If you happen to tear your rotator cuff muscle in the future, the prosthesis will not function well and you may need to have it revised to a reverse shoulder arthroplasty.
- Reverse total shoulder arthroplasty (rTSA). What makes this prosthesis a “reverse” is that we put the ball of the prosthesis on your original socket (glenoid) and the socket is on the humerus, your original ball of your joint. This has quickly become the most common type of shoulder replacement because it is not sensitive to your rotator cuff failing or tearing in the future. As most people old enough to have a shoulder replacement already have some rotator cuff pathology (eg. tearing, severe tendinosis, etc), this is a significant concern. It also tends to be more stable (less prone to dislocating) than an anatomic shoulder replacement. The downside is that it does not quite “feel as normal” as an anatomic shoulder replacement. That being said, pain relief and range of motion improvement are significant after this procedure. Most patients would only be able to tell the difference between this an anatomic shoulder replacement if they had an anatomic on one side and a reverse on the other. For these reasons, this is the most common type of replacement we perform.
Dr. Farjo will order tests (frequently an MRI and a CT scan) and then discuss the appropriate prosthesis for you. Sometimes, there is no one right answer for a particular patient. In this situation, he will explain the pros and cons of the options, and help you make the appropriate decision for yourself.
How Long Does The Procedure Take?
Surgery usually takes 1 – 2.5 hours, depending on what needs to be done. The majority of patients will go home the same day of surgery (outpatient procedure).
What Can I Expect From Surgery?
You can expect to have a significant relief of pain in your shoulder. In addition, most patients will see improvements in range of motion and strength.
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 and 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 two (2) to three (3) months, depending on the patient.
Shoulder Implants
Primary total shoulder
Reverse total shoulder
Normal total shoulder
