If non-surgical treatments do not relieve your shoulder pain and/or stiffness, you may be a candidate for shoulder replacement surgery. Shoulder replacement surgery can alleviate pain and improve motion, strength and function. St. Luke’s Medical Center offers two primary types of shoulder replacement surgical procedures:
Total Shoulder Replacement
Most patients, especially those suffering from arthritis and tendon tears, are generally good candidates for total shoulder replacement procedures. During shoulder replacement surgery, all or part of a problem shoulder is replaced with an artificial joint, called a prosthesis. The prosthesis replaces joint surfaces with a highly polished metal ball attached to a stem and plastic socket (components are available in a variety of sizes).
Depending on the condition of the shoulder, the orthopaedic surgeon may replace only the ball (the humeral head). If the bone is healthy, the orthopaedic surgeon may choose to use a non-cemented or press-fitted humeral component. If the bone is soft, the humeral component may need to be implanted with bone cement. (This decision is usually made in the operating room during surgery.) In most cases, an all-plastic glenoid component (the cup portion of the shoulder joint) is implanted with bone cement. Implanting a glenoid component is not advisable in cases when there is good cartilage, the glenoid bone is severely deficient, or the rotator cuff tendons are irreparably torn.
Reverse Total Shoulder Replacement
The reverse total shoulder replacement option is most effective for those suffering from completely torn rotator cuffs, severe arthritis and/or previously failed total shoulder replacements. For individuals experiencing these conditions, a conventional total shoulder replacement may not alleviate all of the pain and may not enable total rotation or arm movement past a 90-degree angle.
With the reverse total shoulder replacement procedure, the anatomy or structure of the healthy shoulder is reversed. The implant is designed so that the ball portion is attached to the shoulder blade (scapula) where the cup is usually located, and the socket is placed at the upper end of the humerus where the ball is usually located.
Other Shoulder Conditions Treated Surgically
Impingement. Also known as bursitis, tendinitis, and pitcher’s shoulder, impingement occurs when the bursa and rotator cuff become inflamed. Bone spurs may also develop, adding to the discomfort. During surgery, the inflamed bursa is oftentimes removed, bone spurs may be trimmed, and the coracoacromial ligament may be detached to improve range of motion. Athletes who undergo this procedure may work with the St. Luke’s Medical Center Sports Medicine team before and after surgery to help speed their return to the game.
Torn Rotator Cuff. Whether caused by overuse or acute injury, a torn rotator cuff can be uncomfortable and painful, potentially keeping you from performing your daily activities. During a repair procedure, the orthopaedic surgeon may trim torn tendons and reattach them to the humerus with sutures, anchors or surgical tacks.
Stretched Capsule. Stretched capsules are oftentimes the culprits behind shoulders that seem to move too much. Once stretched, a capsule will remain loose until arthroscopically repaired. During this procedure, the stretched capsule is folded over itself and sutured into place, stabilizing the shoulder joint.
Torn Labrum. When the labrum is torn from the rim of the glenoid, the shoulder joint may feel like it’s slipping out of place. In some patients, the shoulder may dislocate entirely. At the Center for Orthopaedic Innovation, surgeons stabilize the joint and repair the torn labrum by reattaching it to the glenoid.
Arthritis and Loose Bodies. Damaged cartilage, bone spurs, and loose matter in the shoulder joint can cause severe discomfort. Using arthroscopic techniques, the orthopaedic surgeons at St. Luke’s Medical Center can remove loose bodies and smooth joint surfaces to help promote healthy new cartilage growth.
What You Can Expect Before, During and After Shoulder Surgery
Candidates for total joint replacement surgery will be encouraged to participate in the Motion Academy Total Joint Replacement class prior to surgery. Click here for more information.
You will need to complete a preoperative medical evaluation with your primary care provider prior to having orthopaedic shoulder surgery at St. Luke’s Medical Center. Those with cardiac conditions may also need to receive a medical evaluation from a cardiologist. If you need a primary care physician or specialist, you may click here for online directory of the physicians and specialists at St. Luke’s Medical Center or call 1-877-351-WELL (9355) for a referral.
Two weeks before surgery, your surgeon may require that you stop taking non-steroidal anti-inflammatory medications (such as aspirin and ibuprofen) and most arthritis medications.
The Day of Surgery
After midnight before your surgery, you should not have anything to eat or drink. Your surgeon will discuss which specific medications to take the morning of surgery. An hour before surgery, you will be assessed in the preoperative area by a St. Luke’s Medical Center nurse anesthetist or anesthesiologist.
Shoulder replacement surgery is performed on an inpatient basis. Most patients are discharged from the hospital on the second or third day after the operation. Your surgeon will work with you to determine if you need an extended care facility or home assistance following hospitalization.
After shoulder replacement surgery, you should experience less pain and stiffness. You may also have more strength and movement in your shoulder and arm and be able to return to many of the activities you enjoy — such as golf, swimming, bowling, gardening and/or playing with your grandchildren. Your surgeon will help you to determine when you can return to work, as this will depend on your surgery and the type of work you do. Most patients are able to perform simple activities, such as eating, dressing, and grooming, within two weeks after surgery. Driving a car is not allowed for at least six weeks after surgery.
A well-planned rehabilitation program is critical to the success of a shoulder replacement — beginning with physical therapy as early as the first day following your surgical procedure. Your surgeon may recommend a few home exercises for you to complete during the first few weeks following surgery.
For more information about your shoulder surgery options at St. Luke’s Medical Center, call 1-877-351-WELL (9355).