Shoulder Arthritis Part Two: What to Know When Considering Shoulder Replacement Surgery

When Shoulder Replacement Surgery is the Best Option
Surgery may be the right choice when pain and stiffness persist despite therapy and medication. There’s no need to suffer. Shoulder replacement has advanced dramatically, offering implants tailored to each patient and condition. Outcomes are better than ever.

Two Surgical Options
There are two surgical options for shoulder arthritis: Partial shoulder replacement (hemi-arthroplasty) and total shoulder replacement (anatomic).

The goal of these surgeries is to reestablish near normal anatomy. The worn-out parts of the shoulder joint are replaced with a custom metal implant on the arm bone (humeral side) that matches your normal anatomy. A stemless design (absence of a long metal rod in the bone) or a stemmed implant is utilized. Stemless designs preserve bone and are less invasive but require good bone quality.

With a partial shoulder replacement, the socket side of the joint (glenoid) is either left alone or symmetrically reamed to create a stable surface. Utilization of this is normally reserved for very young individuals.   

In an anatomic design, the socket is replaced with a plastic component called a “poly” recreating joint spacing and normalizing the shoulder’s center of rotation.

Reverse Shoulder Replacement
The reverse total shoulder brought on a surgical revolution with its introduction into the U.S. in 2002. It has been a breakthrough for complex problems such as irreparable rotator cuff tears, severe bone loss, fractures, and failed prior surgeries. This type of surgery is an anatomy altering procedure in which it reverses or flips the normal anatomy, the native head of the joint becomes the socket, and the native socket becomes a head.

What to Consider Before Surgery
Shoulder replacement is not just about showing up for surgery; it’s a team effort between patient and the surgical team.

Key personal considerations include:

• Have you exhausted conservative care?
• Were your imaging studies (X-ray, CT, MRI) thoroughly reviewed? Bring copies to every appointment.
• Have you completed dental, medical and infection screenings?
• Does the team offer postoperative multimodal pain control and ultrasound-guided nerve blocks?
• Is outpatient surgery an option?
• Which implant is recommended and why?
• Is there an emphasis on surgical precision?
• Do you trust and feel comfortable with your surgical team? (Never hesitate to seek a second opinion.)

Key technical considerations include:

• Preservation of key muscles, such as the subscapularis.
• Preoperative 3D computer navigation for precise implant positioning.
• Use of tranexamic acid to minimize bleeding.
• Specialized shoulder tables and positioning devices for optimal access.
• Bone spur removal to restore motion and relieve pressure.
• A meticulous, minimally invasive “sneak in, sneak out” approach to help your body accept the implant naturally.

If you’re considering shoulder surgery, ask the right questions, stay informed and work with a team that treats you as a partner in your care. Preparation, patience and persistence are the keys to a successful outcome.

What to Expect After Surgery: Recovery and Rehabilitation

• Immediately after surgery, you will be allowed to move your elbow, wrist and fingers actively. Passive shoulder motion (motion without the use of muscle engagement) begins.
• Within a few days, daily activities using the nonsurgical arm become easier.
• Physical therapy begins during the first week.
• In two to four weeks, driving is allowed in addition to active assist range of motion.
• Also, in two to four weeks, gentle home exercises are prescribed with a focus on subscapularis protection.
• In six to 12 weeks, gradual strengthening occurs with sports and recreational activities resuming.
• At six months, most patients return to full function with minimal restrictions. Active participation in golf, swimming, tennis groundstrokes, fitness and strength training, and cardio activities that do not require the full strength of the shoulder are permitted.
• Long-term success depends on staying active in physical therapy for at least the first three months, and ideally continuing a home program for life to maintain shoulder health.

Final Thoughts
Shoulder arthritis is painful, but it doesn’t have to define your life. Whether you continue with conservative care or choose surgery, a dedicated team should guide you every step of the way.

The best surgery is one where it seems as if the surgeon was never there – where pain is gone or greatly reduced, and movement feels natural once again. FBN

By Dr. Yuri Lewicky, M.D.

Dr. Yuri Lewicky, M.D., is a double board-certified Orthopaedic Surgeon who specializes in shoulder surgery and sports medicine. He practices in Flagstaff and Prescott Valley at Northern Arizona Orthopaedics and can be reached at 928-226-2900, NorthAzOrtho.com

Courtesy Photo: The reverse total shoulder surgery is a breakthrough for complex problems such as irreparable rotator cuff tears, severe bone loss, fractures and failed prior surgeries.