Total Shoulder Replacment
Total shoulder replacement (arthroplasty) surgery is a surgical procedure in which the complete shoulder joint is removed and replaced by a specially designed artificial implant. The goal of the surgery is to relieve pain caused by an arthritic condition or fracture while maintaining the shoulders natural range of movement.
Many candidates for total joint replacement suffer from osteoarthritis,a complete rotator cuff tear, or a severe fracture. Arthritis (joint inflammation) is condition that is usually occurs as a result of a joint disease. Any joint in the body can be affected by arthritis but one of the most common types of arthritis that affects the shoulder is osteoarthritis. Osteoarthritis is a joint disease in which the cartilage that separates the joint breaks down or completely deteriorates. Once cartilage wears away, bone on bone contact occurs. The friction caused from joints rubbing together may cause pain when rotating, swinging or having the arm in certain positions. The affected joint may try to compensate for the lost cartilage by slowly developing small bone deposits around its edges. If this occurs, the small bone deposits may grow in area of the shoulder that is reserved for a specific shoulder movement. Difficulty raising or rotating the arm may follow along with a locking or stiffness sensation during other shoulder movement.
Rotator cuff tears can be a result of a longstanding overuse condition, aging, or a bad fall in which the arm is abnormally stretched. Athletes commonly sustain rotator cuff injuries because of the constant strain on rotator cuff tendons and muscles. Partial rotator cuff tears often do not require surgery as anti-inflammatory medication and rest can be all that is necessary for recovery. If a partial rotator cuff tear does not heal properly, surgeons can perform a minimally invasive arthroscopic procedure to remove torn fibers within the tendons. Complete rotator cuff tears require surgery to replace tendons that have completely detached from their origin. Repeated rotator cuff surgeries or tears may lead to an irreparable condition referred to as cuff tear arthropathy. In cuff tear arthropathy, the rotator cuff becomes so badly damaged that it is no longer feasible to attempt reconstruction. Individuals who suffer from cuff tear arthorpathy may be a candidate for reverse total shoulder replacement. Reverse total shoulder replacement makes use of the deltoid muscle instead of the rotator cuff to raise the arm.
A severe shoulder fracture may also require total shoulder replacement surgery due to damages sustained by the humerous head or glenoid. Insufficient blood flow to the fractured area often times makes shoulder replacement surgery the best alternative.
Total shoulder replacement surgery and reverse total replacement surgery are similar in nature in regards to how the surgeries are performed. Both procedures require a general anesthetic. This is a drug that will keep your muscles relaxed and keep you from feeling pain. Both procedures also require a small incision over the shoulder to expose the shoulder joint. The next step requires the surgeon to detach the humerous bone from the scapula. The following steps lie the differences between a total shoulder replacement and a reverse total shoulder replacement procedure. In a standard total shoulder replacement procedure, your surgeon will cut off the humerous head and insert an artificial metal ball with a stem in its place. The glenoid (socket) portion of the joint is prepared and plastic liner is cemented into place thus creating a new socket. The rotator cuff muscles are then reattached and the wound is closed. With reverse total shoulder replacement, your surgeon will again cut off the humerous head and insert an artificial metal device with a stem into the humerous bone. However, the artificial device inserted into the humerous bone will be the socket and a metal ball is attached to the scapula bone in place of the glenoid (socket). Since this procedure is commonly performed when rotator cuff muscles have deteriorated, surgeons attach tendons necessary to allow the center of rotation to be shifted to the deltoid muscle. The wound is then closed and the surgery is concluded.