Why Shoulder Replacement Surgery

The shoulder joint is the most mobile joint in our body. It rotates to 180 degrees in three directions.This freedom of movement is absolutely necessary for all day-to-day functions in our life. When your shoulder is healthy, you may take it for granted, not giving a thought about the job it does for you. But once it starts to become painful and stiff, and you are forced to restrict certain activities, you may come to realize how much freedom of movement means to you.

Fortunately, today’s advanced medical technology makes it possible to replace the shoulder joint with an artificial one that reduces pain, allows you movement and improves your quality of life.

Shoulder replacement is the third commonly performed joint replacement surgery, next to hip and knee.

Shoulder is a complex joint. The main articulation is called Glenohumeral joint. This is the ball and socket type of joint where the head of upper arm bone (humerus), meets the shoulder blade bone (scapula). The socket portion is called the glenoid, hence the name Gleno-Humeral joint. This is responsible for majority of movements of shoulder girdle.

How arthritis is caused?

The shoulder joint is an extremely mobile ball and socket joint. This is in contrast with the lower limb joints like hip and knee, which are mainly, weight-bearing joint. Shoulder joint moves to 180 degrees in three planes, namely forward, sideways and rotation. The humeral head is five times the surface of the socket. It is like a golf ball on the tee. So, through out the range of movement, the ball needs to be stabilized against the socket.

This is done by labrum and ligaments, which acts like a bumper all round the socket, deepening it, providing a suction effect on the ball. The second important factor is the rotator cuff, whichis a group of four muscles in the shoulder that provides both stability and rotating movements of the shoulder joint. Together, they stabilize the ball against the socket, there by allowing the big shoulder girdle muscles to move effortlessly. Structurally, the joint needs good bone on the ball and socket with good cartilage cover.

When any of these things go wrong, shoulder arthritis develops.

Shoulder replacement surgery is considered for patients whose shoulder joints have been damaged by progressive arthritis, trauma, or other rare destructive diseases of the joint.

Common indications are:

1. Primary Osteoarthritis of shoulder
2. Avascular necrosis of humeral head
3. Rheumatoid Arthritis of shoulder
4. Post Traumatic Arthritis
5. Severe acute fractures
6. Cuff Tear Arthritis
7. Irreparable massive Rotator cuff tear
8. Bone tumors
9. Failed Trauma surgery
10. Failed shoulder replacement surgery

In the initial stages, the pain can be helped with anti inflammatory tablets and physiotherapy. Steroid injection is not routinely recommended. In selected cases, Arthroscopic debridement can help to relieve symptoms in the early stages only.

When the arthritis is advanced, the only successful treatment is by shoulder replacement.

Once the new joint has completely healed, the patient will reap the benefits of the surgery. These include:

• No pain
• Painless range of movement
• Improved quality of life and ability to return to normal activities and pastimes.

Most likely, lifting weights and high – impact activities will be discouraged.

As with any major surgery, there are potential risks involved. Your surgeon will explain the potential risk and complications of shoulder replacement. Possible complications include risk of infection, nerve injury and issues related to longevity of prosthesis. When complications occur, most are successfully treatable. A few may require revision surgery in future.