Ethan R. Wiesler, MD, an orthopaedic surgeon at Wake Forest Baptist Medical Center, performs a total shoulder replacement.
Christopher J. Tuohy, MD, an orthopaedic surgeon who also performs shoulder replacements, narrates the procedure.
The most common reason for needing a shoulder replacement is osteoarthritis, which causes a deterioration of the joint. Other causes are rheumatoid arthritis and trauma to the joint. Arthritis and trauma can cause pain, inflammation, swelling and stiffness in the joint, decreased activity and an impaired lifestyle, including an inability to sleep or use that shoulder.
In addition to damage to the arm bone and shoulder blade within the joint, patients may have damage to the cartilage that supports the joint. Conservative treatments include lifestyle changes, less invasive surgeries, physical therapy, supplements, rest and ice, as well as pain management that includes anti-inflammatory medications, analgesics and steroid injections.
If these treatments do not work, a patient may need to explore shoulder replacement. In order to properly diagnose shoulder problems, physicians will perform a complete medical history, a complete physical exam of the patient and a detailed exam of the affected joint, X-rays and a CT scan.
The benefits of replacement of the shoulder joint include pain relief, enhancement of movement and mobility and improved quality of life. Replacement of the joint includes resurfacing or replacing the humeral head, which is the top or ball of the humerus or long arm bone, and the glenoid or socket of the joint that is part of the scapula or shoulder blade.
Standard components for a total shoulder replacement include the humeral stem, which goes down into the long arm bone called the humerus; the humeral head, which replaces the ball or rounded top of the humerus bone; and the glenoid components which replaces the socket that is part of the shoulder blade and attaches to the shoulder blade.
With total shoulder replacement, regional anesthesia in addition to general anesthesia will be given to the patient to assist with pain management following surgery. The surgeon will replace the damaged shoulder joint by resurfacing the bone ends of the arm bone and shoulder blade, capping with metal pieces and placing plastic in between to ensure support, flexibility and motion, without the pain.
A variety of designs of shoulder joints are available, including one used for partial shoulder replacement that is as simple as replacing only the humerus head or top of the arm bone. The appropriate size and design is based on the patient's condition, age, weight, activity, and health.
During a total shoulder joint replacement, the physician trims off the top of the arm bone and prepares the hollow inside of the arm bone for the stem. Any remaining cartilage inside the glenoid or socket is cleared way using a burr, which also drills the holes inside the shoulder blade used for anchoring the glenoid tray.
The humeral stem is placed inside the top of the bone. The glenoid component is placed inside the old socket. The humeral ball is attached to the top of the stem. The joint is then tested for a proper fit.
After surgery, supervised physical therapy will continue for about three months. After about six months, the patient should be able to return to full activities.
Joint replacement patients are cared for by physicians, physical therapists, nurses and staff who all have special training in joint replacement care. In addition to the high volume of joint replacements, resurfacings, repairs and preservations, Wake Forest Baptist Medical Center also does research and trains future surgeons.