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Shoulder replacement

What is shoulder replacement surgery?

Shoulder replacement is a procedure which replaces a worn-out shoulder joint, which is a ball and socket joint. It restores function and most importantly relieves pain.

Shoulder joint replacement surgery is less common than knee or hip replacement surgery, but it is a safe and effective procedure for relieving severe shoulder pain associated with conditions such as shoulder osteoarthritis and severe rotator cuff injuries.

It is normally only offered when other, less invasive procedures, such as medication and pain-relieving injections, are no longer effective or if you have a severe shoulder fracture.

If you have pain and stiffness in your shoulder joint, your consultant will assess you and may request X-rays, MRI scans and a CT scan. The decision-making process will review the condition of your ball and socket shoulder joint and also the state of your rotator cuff.

Why might I need shoulder replacement surgery?

The shoulder is a ball and a socket joint with a large ball and a shallow socket to allow a larger range of movement than any other joint in the body. It can be compared to a golf ball and tee. The shoulder’s stability relies on the surrounding soft tissues including the muscles and tendons which form the rotator cuff and the shoulder capsule, which is the ligament surrounding the shoulder joint.

The joint surfaces are covered with articular cartilage, which allows for frictionless movements of the joint.  The rotator cuff muscles keep the shoulder centred.

Two types of arthritis develop in the shoulder joint, one with an intact rotator cuff known as osteoarthritis of the shoulder joint and the other where the rotator cuff is deficient (rotator cuff arthropathy), which develops with irreparable degenerative rotator cuff tears. This decompensates the humeral head and leads to superior migration of humeral head causing impingement, pain and stiffness (pseudo paralysis).

The type of joint replacement required varies according to the type of arthritis involved. An arthritic shoulder with intact rotator cuff would need a total shoulder replacement that mimics the normal anatomy of the shoulder joint.  Rotator cuff arthropathy requires a reverse shoulder replacement, where the ball and socket are switched to improve shoulder function. This type of shoulder replacement relies on the outer deltoid muscle to power the shoulder. Some shoulder fractures especially in elderly population are also treated with this kind of shoulder replacement to improve function.

In addition to this, trauma is also a causative factor in the development of shoulder arthritis. If the head of the upper arm bone is shattered, fixing the fracture may lead to a very poor outcome with longstanding pain and poor function and a shoulder replacement may be recommended. This is particularly common in older patients with osteoporosis.

Shoulder replacement surgery

Shoulder and elbow consultants

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