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Your shoulder joint replacement guide
Ready to consider shoulder joint replacement? Some things you should
know…
Replacement of an arthritic or injured shoulder is less common than knee or hip
replacement. When necessary, however, shoulder replacement typically provides the
same benefits as those procedures, including relief of joint pain and restoration of more
normal joint movement.
Restoration of movement is particularly important in the shoulder -- the body mechanism
that allows your arm to rotate in every direction. If you're experiencing severe shoulder
pain and reduced shoulder movement, there are probably many daily activities you can no
longer do, or do as well or comfortably, as before your shoulder problems began.
Understanding how shoulders work
By understanding how a normal, healthy shoulder works, it will be easier for you to
understand the way a shoulder joint prosthesis, or artificial shoulder joint, works -- and the
difference it may make in your life.
A joint is formed by the ends of 2 or more bones that are connected by thick bands of
tissue called ligaments. The shoulder typically involves 2 bones:
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The scapula (shoulder blade)
The humerus (upper arm bone)
The rotator cuff -- 4 muscles connecting the humerus with the scapula -- supplies stability
and balance to the shoulder joint. Proper rotator cuff balance is essential for arm raising
and rotation. When you raise your arm, the rotator cuff holds the humeral head tightly
within the socket (glenoid) of the scapula.
A smooth substance called articular cartilage covers the surface of the bones where they
touch each other within a joint. This articular cartilage acts as a cushion between the
bones. In addition, lubricated sacs of tissue called bursae (singular: bursa) also protect
muscles and tendons, allowing them to slide against each other with less friction. In the
shoulder, one of these bursae is located between the rotator cuff and the acromion -- the
part of the scapula that "roofs" the shoulder. As with other joints, the remainder of the
shoulder joint surfaces is covered by a thin, smooth tissue liner called synovial membrane,
which makes a small amount of fluid that acts as a lubricant so that the joint bones will not
rub against each other.
What causes shoulder joint pain?
One of the most common cause of joint pain is arthritis. The most common types of
arthritis are:
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Osteoarthritis (OA) -- sometimes called degenerative arthritis because it is a
"wearing out" condition involving the breakdown of cartilage in the joints. When
cartilage wears away, the bones rub against each other, causing pain and
stiffness.
The most common cause of shoulder replacement, OA can occur without a
shoulder injury, but this seldom happens since the shoulder is not a weight-bearing
joint like the knee or hip. Instead, shoulder OA commonly occurs many years
following a shoulder injury, such as a dislocation, that has led to joint instability and
repeated shoulder dislocations, damaging the shoulder joint so that OA develops.
When the resulting joint pain and stiffness become severe enough to affect a
person's daily life and comfort, shoulder replacement may be recommended.
Post-traumatic arthritis -- may develop after an injury to the joint in which the
bone and cartilage do not heal properly. The joint is no longer smooth, and these
irregularities lead to more wear on the joint surfaces.
Rheumatoid arthritis (RA) -- produces chemical changes in the synovium that
cause it to become thickened and inflamed. In turn, the synovial fluid destroys
cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women
about 3 times more often than men, and may affect other organs of the body.
Other causes of joint pain include avascular necrosis, which can result when bone is
deprived of its normal blood supply (for example, after organ transplantation or long-term
cortisone treatment), and deformity or direct injury, such as a fracture, to the joint.
In some cases, joint pain is made worse by the fact that a person will avoid using a painful
joint, weakening the muscles and making the joint even more difficult to move.
What's causing your shoulder joint pain? Is getting relief through joint replacement an
option for you? These are just some of the answers that an orthopedic surgeon can
provide. But first, it's a good idea to be sure you have information about joint replacement
that will help you understand what the surgeon tells you.
Learning what you should know about total shoulder joint replacement
"Total joint replacement" (the term orthopaedic surgeons use) is usually reserved for
patients who have severe arthritic conditions. However, when appropriate, the operation is
being performed in greater numbers on younger patients thanks to new advances in
artificial joint technology.
Circumstances vary, but generally patients are considered for total joint replacement if:
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Functional limitations restrict not only work and recreation, but also the ordinary
activities of daily living.
Pain is not relieved by more conservative methods of treatment -- such as
medications (including, for the shoulder, injections of cortisone, a powerful antiinflammatory medication) and physical therapy -- and/or by restricting activities.
Stiffness in the joint is marked and, in the shoulder, significantly limits range of
motion of the arm.
X-rays show advanced arthritis or other problems.
"Every day you get a little better. And the therapy -- you get used to it. Once
they loosen you up, it's no problem."
What is total joint replacement?
Total joint replacement is a surgical procedure in which certain parts of an arthritic or
damaged joint, such as a shoulder joint, are removed and replaced with a plastic or metal
device called a prosthesis, or artificial joint. The artificial joint is designed to move just like
a normal, healthy joint.
The artificial shoulder joint can have either two or three parts, depending on the type of
surgery required.
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The humeral component (metal) is implanted in the humerus.
The humeral head component (metal) replaces the humeral head at the top of the
humerus.
The glenoid component (plastic) replaces the surface of the glenoid socket.
There are two types of shoulder joint replacement procedures:
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A partial shoulder joint replacement is used when the glenoid socket is intact and
does not need to be replaced. In this procedure, the humeral component is
implanted, and the humeral head is replaced.
A total shoulder joint replacement is used when the glenoid socket needs to be
replaced. All three shoulder joint components are used in this procedure.
"You're like a new person afterwards. You have to go through the therapy,
but each day you get better and better, and the pain just goes and goes."
Possible complications of surgery
The complication rate following joint replacement surgery is very low. Serious
complications, such as joint infection, occur in less than 2% of patients. Besides infection,
possible complications include blood clots and lung congestion, or pneumonia. Some
shoulder-specific complications that may occur are nerve injury -- since many major
nerves and blood vessels travel through the armpit (axilla) -- and dislocation, particularly
just after the replacement surgery. Fortunately, the vast majority of surgical complications
associated with joint replacement can be successfully avoided and/or treated.
Will an artificial shoulder joint last forever?
As successful as most of these procedures are, over the years, the artificial joints can
become loose and unstable or wear out, requiring a revision (repeat) surgery. These
issues -- together with the fact that increasing numbers of younger and more active
patients are receiving total joint replacement, and patients are living longer -- have
challenged the orthopaedic industry to try to extend the life cycle of total joint
replacements.
Recent improvements in surgical techniques and instrumentation will help to further the
success of your treatment. The availability of advanced materials, such as titanium and
ceramic prostheses, and new plastic joint liners provides orthopaedic surgeons with
options that may help to increase the longevity of the artificial joint.
Having an orthopaedic evaluation
If you're ready to consider having shoulder joint replacement, the next important step is to
talk with an orthopaedic surgeon. The medical management of arthritis and joint
degeneration may be handled by a family doctor, an internist, or a rheumatologist.
However, when medical management is not effective, an orthopaedic surgeon should be
consulted to determine if surgery is an option. In some cases, the orthopaedic surgeon
may be the first physician to see a patient and make the diagnosis of arthritis.
"I would recommend asking questions and writing them down."
While every orthopaedic evaluation is different, there are many commonly used tests that
an orthopaedic surgeon may consider in evaluating a patient's condition. In general, the
orthopaedic evaluation usually consists of:
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A thorough review of your medical history. In particular, your orthopaedic surgeon
will ask you to describe any previous shoulder injuries.
A physical examination. The surgeon will evaluate your strength and range of
motion in your shoulders and look for additional evidence of arthritis.
X-rays. In addition to X-rays that will reveal bone changes in your shoulder and
signs of general joint deterioration, your surgeon may also order an arthrogram (an
X-ray taken to see if a special dye leaks out of the shoulder joint, indicating a
rotator cuff tear) and/or magnetic resonance imaging (MRI) of the shoulder.
Additional tests as needed. These may include laboratory testing of blood, urine, or
joint fluid and/or a bone scan of the joint and surrounding soft tissue.
An abnormal X-ray may reveal:
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Narrowing of the joint space
Cysts in the bone
Spurs on the edge of the bone
Areas of bony thickening called sclerosis
Deformity or incorrect alignment
Other abnormalities
Treatment options
Following the orthopaedic evaluation, the orthopaedic surgeon will review and discuss the
results with you. Based on his or her diagnosis, your treatment options may include:
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Medications, which may include cortisone injections for temporary pain relief
Physical therapy
Shoulder joint fluid supplements (injections that provide temporary pain relief)
Shoulder joint replacement
If you and your orthopaedic surgeon decide that shoulder replacement surgery is an option
to relieve your pain, the orthopaedic surgeon will provide the specific-to-you details of
which type of artificial joint he or she will use, what you need to know to prepare for the
surgery, how the surgery will be performed, and what results you can expect once you're
up and moving again.
Next steps: adjusting to life with less shoulder pain
The vast majority of individuals who have joint replacement surgery experience a dramatic
reduction in joint pain and a significant improvement in their ability to participate in the
activities of daily living.
"The quality of my life has been better now than it has been in the past 10
years!"
Keep in mind, however, that joint replacement surgery will not allow you to do more than
you could before joint problems developed. After joint replacement, a good rule of thumb is
that acceptable physical activities should:
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Not cause pain, including pain felt later.
Not jar the joint, as happens with running or jumping.
Not place the joint in the extremes of its range of motion.
It is also important for an individual with a joint replacement to keep his or her body weight
as close to normal as possible. Joint wear and loosening increase with weight increase.
When fully recovered, most patients with artificial shoulders can return to work and normal
daily activities. However, if you are considering doing any of the following activities -which could affect how long your artificial shoulder will last and how well it will perform -discuss it first with your doctor or orthopaedic surgeon:
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Any activity involving lifting or pushing heavy objects
Any activity that places excessive stress on your shoulder joint
Hammering and other forceful arm/shoulder movements
Boxing and other arm/shoulder impact sports
© Stryker, 2004