Total Shoulder Arthroplasty - An Overview

What Is a Total Shoulder Arthroplasty?

Total shoulder arthroplasty is a procedure used to replace the shoulder's diseased or damaged ball and socket joint with artificial components called prostheses. A metal ball replaces the humeral ball, made out of a special type of stainless steel attached to a stem usually made out of titanium, and keeps the ball attached to the arm. In contrast, a polyethylene cup replaces the glenoid socket. The most common reasons for total shoulder arthroplasty are osteoarthritis, rotator cuff injuries, avascular necrosis, fractures, or rheumatoid arthritis. The procedure helps eliminate the source of pain, improve strength, increase the range of motion, and enable the use of the shoulder and arm.

Why Is a Total Shoulder Arthroplasty Done?

Total shoulder arthroplasty relieves pain, dysfunction, and other symptoms resulting from damage to the shoulder joint. Conditions that can damage the shoulder joint include:

• Osteoarthritis: It is commonly known as wear-and-tear arthritis, osteoarthritis damages the cartilage that protects the bone ends and helps joints move smoothly. Unfortunately, there is no mode to prevent the development of osteoarthritis.

• Osteonecrosis or Avascular Necrosis: It is a painful shoulder disorder that can affect the blood supply to the humerus (the longest bone of the upper limb). When a bone is deprived of blood, it can collapse. Chronic steroid use, deep sea diving, sickle cell disease, severe fracture of the shoulder, and heavy alcoholism are all risk factors for osteonecrosis.

• Rotator Cuff Injuries: A rotator cuff is composed of muscles and tendons surrounding the shoulder joint. Rotator cuff injuries can damage cartilage and bone in the shoulder joint sometimes.

• Rheumatoid Arthritis: This occurs due to an overactive immune system, the inflammation associated with rheumatoid arthritis can damage the cartilage and sometimes the underlying bone in the joint and eventually cause cartilage loss, pain, and stiffness.

• Fractures: A severe fracture of the upper end of the humerus is another common reason people may require total shoulder arthroplasty. Older individuals with osteoporosis are most at risk for severe shoulder fractures.

• Failed Previous Surgery: Although rare, some shoulder arthroplasties fail, usually because of implant loosening, wear, infection, and dislocation. A second shoulder arthroplasty, called revision surgery, may be necessary in such cases.

Generally, all other ways of treatment are considered first, such as drugs or physical therapy. However, if these do not work, the healthcare provider may recommend surgery.

What Are the Types of Total Shoulder Arthroplasty?

Depending on the type of joint damage one has, the healthcare provider may recommend one of the following options:

• Anatomic Total Shoulder Arthroplasty: It involves replacing the arthritic joint by a highly polished metal ball connected to a stem and a plastic cup on the glenoid socket. Individuals with bone-on-bone osteoarthritis and intact rotator cuff tendons are ideal candidates for conventional total shoulder arthroplasty.

• Stemless Total Shoulder Arthroplasty: It is a bone-preserving form of total shoulder arthroplasty where the metallic ball is connected to the upper arm without a stem. Its bone-preserving advantage offers arthritis of the shoulder an alternative to the standard stemmed shoulder replacement.

• Reverse Total Shoulder Arthroplasty: In this version of arthroplasty, the joint is reversed, the metal ball is kept in the glenoid socket, and a plastic cup is connected to the stem and is moved to the upper arm bone (humerus). This enables the individual to use the deltoid muscle instead of the torn rotator cuff to lift the arm. The reverse total shoulder arthroplasty is used for individuals with completely torn rotator cuffs with extreme arm weakness, the effects of severe arthritis, rotator cuff tearing, or a previous shoulder arthroplasty that failed.

How to Prepare for Total Shoulder Arthroplasty?

The healthcare provider conducts a complete physical examination several weeks before surgery to ensure the person is healthy enough to undergo surgery and complete the recovery process. Many people with chronic medical conditions, such as heart disease, must be evaluated by a specialist before the surgery. Follow the healthcare provider's directions regarding eating, bathing, and taking medicines the day before and on the day of surgery. Some medications may be discontinued because they might complicate surgery. One may also need to discontinue anti-inflammatory medications, including Aspirin, Ibuprofen, and Naproxen, a week before surgery unless instructed otherwise.

What Happens During the Total Shoulder Arthroplasty?

The surgeon discusses the type of anesthesia to be used. Most people receive general anesthesia and a nerve block. General anesthesia puts one into a deep sleep for the entire operation. The nerve block numbs the shoulder, so pain control can continue after one wakes up from general anesthesia. The procedure usually takes one to two hours. After surgery, the person will be moved to the recovery room for a short time. Meanwhile, their recovery from anesthesia is monitored. After they wake up, they will be taken to the hospital room. How long one stays after surgery depends on the person's needs. Most individuals can go home that same day.

How Long Does Total Shoulder Arthroplasty Take To Heal?

Recovery varies from person to person, depending on the surgery type. The healthcare provider will give antibiotics to prevent infection. Most people can eat solid food and get out of bed the day after surgery. One will likely be able to go home on the first, second, or third day after surgery. The healthcare provider may advise specific precautions, including the following:

• Drive as instructed by the healthcare provider.

• Avoid lifting heavy objects for two months. Avoid any repetitive heavy lifting.

• Resume active movement of the arm within limits of pain.

• Continue exercises at home as the physical therapist and other healthcare providers instruct.

• Do not play contact sports.

• Refrain from using the operative arm to push up from a bed or chair.

• Avoid placing the arm in extreme positions for the first six weeks after surgery. An example is not stretching the arm straight to the side or behind the back.

What Are the Complications of Total Shoulder Arthroplasty?

Several possible complications follow total shoulder arthroplasty:

• Infections: Infections can occur at the wound or deeper tissue. Major infections may require surgery to treat them.

• Dislocation: In the case of total shoulder arthroplasty, the implant may dislocate, requiring closed reduction or surgery to reduce or revise the implant.

• Nerve Injury: Nerves in the area where the implant is positioned can be damaged, which can cause numbness, weakness, and pain.

• Other Prosthesis Problems: Prostheses may wear down, and sometimes the components may get loose. Additional surgery is sometimes needed.

• Blood Clots: They can form in the arm's veins after surgery. This can be serious because a piece of a clot breaks off and passes to the lung, the heart, or, rarely, the brain.

• Rotator Cuff Failure: The muscles and tendons surrounding the shoulder joint (the rotator cuff) sometimes wear out after total shoulder arthroplasty.

• Fracture: The scapula, humerus, or glenoid bone can break during or after surgery.

Conclusion

The shoulder rotates with a greater range of motion than other joints. The healthcare provider might consider total shoulder arthroplasty if it causes extreme pain, discomfort, or symptoms. Total shoulder arthroplasty is a procedure in which shoulder-damaged parts are replaced with artificial components called a prosthesis. This procedure helps relieve pain, increases mobility, and enables shoulder and arm use.