While less common than knee or hip replacements, shoulder arthroplasty is equally effective in alleviating chronic shoulder pain. This surgical procedure has evolved significantly since its inception in the 1950s, initially used to treat severe fractures. Today, it’s employed to address a wide range of painful shoulder conditions.
When is Shoulder Arthroplasty Considered?
Shoulder arthroplasty should only be considered as a last resort, after exhausting all conservative and rehabilitative treatment options.
Understanding the Shoulder Joint The shoulder joint is a complex structure comprising three bones: the humerus, scapula, and clavicle. These bones form two distinct joints: the acromioclavicular and glenohumeral joints. The joint surfaces are cushioned by cartilage, a smooth tissue that facilitates effortless movement. Additionally, the synovial membrane, which lines part of the joint, produces lubricating fluid that minimizes friction.
The Benefits of Shoulder Arthroplasty
This intricate design enables the shoulder to rotate through a wider range of motion than any other joint in the body. Shoulder arthroplasty involves replacing damaged components of the shoulder joint with artificial prostheses. Treatment options may include replacing the head of the humerus or both the head and the glenoid cavity.
Instructions
Several conditions can cause shoulder pain and disability, leading patients to consider arthroplasty.
Osteoarthritis (degenerative joint disease): This is an “exhausting” type of age-related arthritis. It usually occurs in people over the age of fifty, but in rare cases it can also occur in younger people. It is caused by a progressive thinning of the articular cartilage which, no longer able to play its role as a “joint shock absorber”, allows the bone heads to rub against each other. Thus, over time, the joint becomes progressively stiff and painful.
Rheumatoid arthritis: A rheumatological disease that causes chronic inflammation of the synovial membrane, resulting in damage to articular cartilage.
Rheumatoid arthritis is the most common form of a group of disorders known as inflammatory arthritis.
Post-traumatic arthritis: A form of arthritis following a serious injury to the shoulder. Bone fractures or damage to tendons and ligaments can lead to rapid deterioration of articular cartilage, causing pain and functional limitation.
Vascular necrosis: Avascular necrosis is a painful condition that occurs when the blood supply to the bone is interrupted, leading to the death of the cells that make up the bone. Possible causes leading to the development of this condition are: chronic steroid use, severe shoulder fracture, hematological diseases and alcohol abuse.
Severe fractures: Poorly treated fractures can lead to progressive deformation of the joint itself.
Failure of a previous arthroplasty operation: an increasingly frequent occurrence in recent years, caused mainly by infection or dislocation of the implant. When this happens, you’ll need to undergo a second operation called revision surgery.
Symptoms and diagnosis
There are several reasons why your orthopaedic surgeon may recommend shoulder arthroplasty. People who benefit from surgery often have:
severe shoulder pain that interferes with daily activities, such as reaching for high cupboard shelves, combing hair or taking a bath ;
- moderate to severe pain during sleep;
- loss of range of motion and/or shoulder weakness;
- failure to improve with other treatments such as anti-inflammatory drugs, cortisone injections or physiotherapy.
Your family doctor can refer you to an orthopedic surgeon for a thorough evaluation, which includes several components:
Medical history: the orthopedic surgeon will gather information on your general health, focusing on the extent of pain and limitation of normal daily activities.
Physical examination: assessment of shoulder movement, stability and strength.
X-rays: a test to determine the extent of damage. They can show loss of joint space between the bones, flattening or irregularity of bone shape, or the presence of tendon calcifications.
Other tests: you may also need blood tests, magnetic resonance imaging (MRI) to assess soft tissue, or computed tomography (CT) to determine the condition of the bone.
Based on the results of the various tests, the surgeon will indicate the best course of treatment to relieve pain and improve functionality, taking into account different types of treatment, including medication, injections, physiotherapy or other types of surgery treatment.
Surgical treatment in Turkey
There are different types of shoulder prosthesis in Turkey, and the surgeon must carefully assess each patient’s situation before making any decision, to ensure the best possible outcome. Total shoulder prosthesis, typically performed through total shoulder arthroplasty, involves replacing the joint surfaces with prosthetic components made of metal and polyethylene. These components come in various sizes and may or may not be cemented. If the bone quality is good, the surgeon may opt for a cementless (press-fit) humeral component, while in cases of bone deterioration, a cemented humeral component may be used. In most cases, a plastic glenoid component is also implanted.
Shoulder endoprosthesis: Depending on the condition of the shoulder, the surgeon may replace only the humeral head. This procedure is called hemiarthroplasty. In a traditional hemiarthroplasty, the humeral head is replaced by a metal prosthetic component consisting of a stem on which a sphere is placed, thus reproducing the normal anatomical components. Hemiarthroplasty is recommended when the humeral head is severely degenerated but the other joint components are normal.
Resurfacing shoulder prosthesis: involves replacing the articular surface of the humeral head with a stemless capped prosthesis. This may be a valid option if (a) the glenoid articular surface is intact; (b) there is no fracture of the neck or humeral head; (c) in young or very active patients, avoiding the risks of component wear and loosening that could occur with conventional total shoulder arthroplasty. Moreover, given its more conservative nature, the hemicephalic prosthesis may be easier to convert into a total shoulder prosthesis when required.
