Shoulder Replacement Surgery Overview
Shoulder joints are the most used and flexible joints in the human body. The shoulder joints are made in a ball-and-socket form where the head of the upper arm bone – the ball portion of the humerus – is fitted into the disc-shaped space – the glenoid cavity – in the shoulder blade. A group of four muscles with their tendons or rotator cuffs, holds both of the bones together to keep a stable joint and makes lifting of the arm possible.
This way our hands can be lifted and moved however we want, like when cooking or playing sports, working, rotating arms, doing workouts, and many more countless activities. Due to the same reason, the shoulder might get overused and lead to injuries or damage, especially if you are over your 40s. But athletes also might face a large number of injuries. You will get severe pain and will not be in a position to move your shoulders because of the stiffness and it will not heal with medication or physiotherapy.
This is where shoulder arthroplasty would be recommended. Depending on your problem, the arthroplasty could be done in either primary or reverse mode. Primary arthroplasty is the replacement of your shoulder joints in the standard anatomical way of a human shoulder. While the reverse arthroplasty is done the opposite way of the normal human anatomy.
Dr Bharani Kumar Dayanandam at Chennai Orthopaedics is a popular orthopaedic and arthroplasty surgeon who provides the best primary and reverse total shoulder arthroplasty in Chennai.
Let us discuss the two types of arthroplasty in more detail.
Understanding Shoulder Arthroplasty
Arthroplasty refers to replacement of joints, and shoulder replacement, or shoulder arthroplasty is done when it undergoes severe injuries, like rotator cuff tears, osteoarthritis, avascular necrosis or rheumatoid arthritis and similar damages. Arthroplasty in shoulders is done to relieve pain and for the person to be able to use the shoulders fully and strengthen themselves and the arm.
The shoulder injuries may damage the upper arm bone head (humeral head), which is like a ball and also the glenoid surface (the socket). In some cases the tendons or muscles may be affected severely. A total shoulder replacement replaces the ball and socket artificially, which is then fitted together with screws to allow the person to get back into doing normal activities.
Primary shoulder replacement or arthroplasty, is done in a way which mimics the natural anatomy of the shoulders. Here the rotator cuff will remain strong like before, as it is not the part injured.
Reverse shoulder arthroplasty Chennai is done for people with severe rotator cuff tears, arthritis, or a previously failed surgery that will not allow the proper shoulder movement. This is normally done in cases where the cuffs have got damaged. The arm muscles or deltoid, will help in the shoulder movement.
Who Needs Shoulder Replacement?
Some shoulder pains or conditions can be effectively treated with physiotherapies, injections, or medications or even arthroscopic surgeries. But getting a total shoulder replacement is very much necessary if you are suffering from chronic conditions like
- Cuff tear arthropathy (rotator cuff tear with arthritis)
- Rotator cuff tears
- A previous failed shoulder replacement surgery
- Chronic shoulder dislocation
- Tumor in the humerus
- Shoulder fracture
- Implant loosening in the previous surgery
- Post-traumatic arthritis
Shoulder replacement is focused on providing the patient with pain relief and strengthening and using your shoulder and arms again as easily as it was before getting the condition.
Primary vs Reverse Shoulder Arthroplasty
The difference between primary and reverse shoulder arthroplasty is that in the primary replacement, a prosthesis ball is fitted into the humerus and is fixed into an artificial socket fitted in the scapula (shoulder blade) as it is in the natural human anatomy. The movement is assisted well by the rotator cuff as usual. This is done in people who have chronic pain and stiffness due to severe arthritis or damage to the bones of the joint because of any injury and won’t heal with medicines, injections or physical exercises.
Reverse shoulder replacement is done for people who have their rotator cuff severely damaged or torn. Here the prosthesis ball will be fitted into the glenoid cavity of the scapula and the socket will be fitted in the humerus – the reverse way of the human anatomy. After the recovery, the arm muscles (the deltoid) will take a lead in free shoulder movement as the rotator cuff muscles are weak. Reverse replacement is done usually when people have severe cuff damage or injuries where it gets torn, and have rotator cuff tear arthropathy, failure in a previous shoulder replacement surgery, fracture or tumour in the humeral head, etc. With a reverse shoulder arthroplasty, the patient gets back the shoulder stability and pain relief with enhanced mobility and freedom.
Surgical Procedure Overview
The preparation stage
Before the procedure begins, you will have to get into a detailed discussion with your doctor to tell about your concerns and what all medications you are taking and for what health conditions they have been given.
If you must stop any medication before surgery, it will be mentioned, as blood-thinning medications are risky in surgical procedures. You are not supposed to eat or drink the previous night of the surgery day.
You also may need to take X-rays, MRIs and CT scans for clear details.
The surgery
Before the procedure begins, you will be given a general anaesthesia for putting you to sleep, a regional anaesthesia for numbing the target area and a combination of both.
The procedure usually takes several hours depending on the problem that you are facing and how severe it is.
Your surgeon will first make an incision on the top of your shoulder, or sometimes in the front. Through the incisions the joint will be exposed to get a clear view for the surgery. The damaged part of the bone will be cut off and prepared for implanting the prosthesis.
In primary replacement, the ball will be placed in the cut-off portion of the humeral head that can fit into a prosthetic disc-shaped cavity that will look like the normal human joint.
In reverse replacement, the artificial ball or glenosphere will be fitted in the original socket area and the humeral head will have a prosthetic cup to fit the ball. The fixations in both the procedures will be done with the help of screws and cement.
Once the surgery is done, the shoulder joint is held together with sutures. You will have to keep that shoulder immobile with a sling for some days as prescribed by your doctor.
Benefits of Shoulder Arthroplasty
Shoulder replacement surgery is done for the purpose of enabling a person to do his everyday activities easily with strong, stabilised shoulders and pain relief. There are a lot of benefits, usually lifelong positive results for a person after their shoulder arthroplasty.
- Major pain relief where patients feel very comfortable and confident to do their tasks.
- Enhanced ROM (range of motion), where you can do any type of activity that includes the shoulders.
- Complete restoration of shoulder strength is achieved with proper aftercare and physiotherapy treatments.
- Improved quality of life with no more worries that stop you from doing your tasks.
- Long-term results that can last for years.
- Reduced risk of complications or infections compared to open surgery.
- Also cures any underlying conditions that might have been contributing to the injury or pain.
Recovery & Rehabilitation
The recovery process for the shoulder arthroplasty depends on what your problem was and how severe it was, as the procedure will take more time in solving the issues based on their complexity.
The recovery time is usually dependent on whether it is a primary replacement or a reverse process and if the bones were replaced fully or if its problem area was cut to keep the prosthesis. Bone grafting can also affect the recovery process. You will be given pain medications for managing pain. Initially the hands will be kept in a sling to avoid moving your shoulders.
You will be able to move your fingers, elbow and wrist within the first three weeks. But you will get clear instructions as to when you can move your arms and hands more freely. Movement of the shoulder might take some time, but within the 4th to 6th week, active physiotherapy will begin slowly. From the 8th week to the 12th week, strength training for the rotator cuff or deltoid (depending on the type of arthroplasty) will start.
Active physiotherapy will continue for restoring motion and stabilising the shoulders. It depends on how well you are participating in the same, which will give you long-lasting results and fast healing. You won’t be allowed to lift any weights though for some time.
Why Choose Dr. Bharani Kumar Dayanandam
Dr. Bharani Kumar is a renowned arthroscopic & orthopaedic surgeon and trauma specialist at Chennai Orthopaedics. He has over 21 years of experience in arthroscopic shoulder surgery & joint replacement surgery. He is a former registrar at Prince Charles Hospital as well as the University Hospital of Wales. He has done his MBBS, AFRCS, Diploma in Orthopaedic Engineering and FRCS in trauma & orthopaedics.
He specialises in primary and reverse shoulder arthroplasty, rotator cuff repair and ligament reconstruction. He is well known for his precision-oriented surgical methods with minimally invasive procedures and gives his patients personalised rehabilitation plans while providing care and compassion.
FAQ’s
What is the difference between primary and reverse shoulder replacement?
In primary shoulder replacement the natural positions of ball and socket are maintained with prosthesis models. In the reverse process, the positions of the ball and socket are reversed from the normal anatomy and arm muscles assist arm lifting instead of the rotator cuff.
When is the reverse shoulder replacement recommended?
When the person has a severely torn rotator cuff and is beyond repair with unbearable pain and weakness, a reverse shoulder arthroplasty will be recommended.
How long is recovery after shoulder arthroplasty?
The recovery process is generally 3-6 months but depends on the healing process, how well you are participating in the physiotherapy and your overall shoulder capacity.
Is reverse shoulder replacement safe for elderly patients?
Yes, the procedure is commonly done in elderly people and considered safe if proper exercises, aftercare, and proper evaluation are done before the procedure.
What are the possible surgical risks?
The most common risks are infection, stiffness, implant wear, injury to the nerves, dislocation of shoulders, or pain. While the risks are very rare, the surgeon’s expertise plays a major role in it, and so does the way you are following the aftercare measures like physiotherapy.