Arthritis and Shoulder Joint Replacement

Like arthritis of other joints, arthritis in the shoulder leads to pain and stiffness. Classically there is a significant reduction in external rotation. The pain is felt deep within the shoulder joint and can often disturb sleep. Clinical examination may reveal crepitus (grating noise) and pain on global movement.

There are three major types of arthritis that can affect the shoulder.

Primary Osteoarthritis

Osteoarthritis, or "wear-and-tear" arthritis, is a degenerative condition. The articular cartilage that lines the joint surfaces gets destroyed and the underlying bone rubs and catches against its opposite surface.

Secondary Arthritis

Secondary arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or rotator cuff tear.

Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory condition of the joint lining. This inflamed synovium can erode the articular cartilage and bone away.

There have been significant advances in the design of shoulder prosthesis. These range from humeral head resurfacing to Reverse Geometry Prostheses. The indications for joint replacement have therefore also changed.

Any patient with significant shoulder pain, either from Osteoarthritis, Inflammatory arthritis (Rheumatoid) or even severe cuff deficiency should be referred to a shoulder specialist for consideration of joint replacement.

In my practice I tailor the type of shoulder replacement implanted to the patient, considering the underlying cause o arthritis, the demands the patient will likely put on the new joint, the patient’s age and bone quality. The vast majority of patients who have shoulder replacement surgery need only stay in hospital one night after their operation and may go home the following day. Rehabilitative physiotherapy varies according to which type of implant was used.

Possible implants

1. Resurfacing Hemiarthroplasty

This procedure has a good record of achieving significant reduction in pain symptoms for many years, with low
complication rates. Only the ball of the shoulder joint is replaced.

2. Total Shoulder Replacement

In this operation, both sides of the shoulder joint are replaced. It is a more technically demanding operation than a hemiarthroplasty. The pain relief provided is better than that provided by hemiarthroplasty but unfortunately the lifespan of the implant is probably less than ten years. I therefore reserve this procedure for those patients who have significant erosion on the socket side of their shoulder joint, or are older than 75years of age.

3. Extended Articular Surface Hemiarthroplasty

This procedure again only replaces the “ball” side of the socket. It is used in patients who have arthritis secondary to longstanding rotator cuff tears if their deltoid muscle is funcyioning well has a good record of achieving significant
reduction in pain symptoms for many years, with low complication rates. Only the ball of the shoulder joint is replaced.

4. Reverse Geometry Prosthesis

The operation is performed when patients have arthritis causing significant pain and loss of function as a result of a longstanding rotator cuff repair.

Post-operative Care

Following your surgery:.
- Your shoulder will be in a supportive sling to allow the subscapularis tendin to heal. This tendon is divided to allow access to the shoulder joint and repaired at the end of surgery.
- You will have an icepack to help reduce post op inflammation. I recommend it is applied for 30-45 minutes and then removed for 2 hours before being re-applied. This has been shown to be effective for up to 72 hours post surgery.
- Sutures do not need to be removed. I routinely use absorbable suture. Surgical dressings over the wounds should not be removed for 2 weeks and you should not get the dressing wet during this period.
- Physiotherapy will follow a scheduled program dependant upon the type of surgery that has been performed.
- You will normally stay in hospital one night post surgery and receive prophylactic antibiotics .
- You will probably need regular analgesia for several weeks to allow you to perform your home exercise program.

Shoulder Hemiarthroplasty

Outcome

All these procedures are very good at reducing pain. Improvement in range of motion is less predictable. The soft tissues that encapsulate the shoulder often become contracted as part of the arthritic process. Even with careful surgical release, these chronically damaged tissues may not function completely normally afterwards.

Complications

Complications of shoulder joint replacement are not common but can include
infection, deep venous thrombosis, dislocation, fracture, nerve damage, post operative stiffness, continued pain.