There are a range of surgical options for shoulder replacement, depending on whether you have an intact rotator cuff or not. After careful examination and reviewing your MRI and CT scans, your consultant will make a decision about which implant would be appropriate for you.
Typically, if your rotator cuff is intact, you will get an anatomic or total shoulder replacement. If the rotator cuff is torn, your consultant will perform a reverse shoulder replacement.
There are different types of humeral implants which are long stem, short stem and stemless. These all depend on your bony anatomy and your consultant will discuss these options with you and plan your operation depending on these criteria. The implants are most commonly made of metal including titanium, cobalt chrome alloys, polyethylene. Ceramic shoulder replacements can be used; however, these are relatively new and there are currently no studies comparing the outcomes with other materials.
The new generation of short stems or stem less implants provide better restoration of normal anatomy in young patients where bone preservation is vital. These need a less invasive technique to insert and work to conserve bone stock, allowing for easy revision in the future if this is required.
Options for shoulder replacement surgery include:
Stemmed hemiarthroplasty: only the ball at the top of the humerus is replaced using a metal stem that sits inside the upper arm bone with a metal ball on the top. This type of surgery may be used if the humerus is severely fractured, but the socket remains in good condition.
Resurfacing hemiarthroplasty: This entails replacing just the joint surface at the head of the humerus with a cap-like prosthesis but no stem. This type of surgery may be recommended if you have intact cartilage in the shoulder socket (glenoid) or if there is no fracture of the humeral neck or head. It is ideal for younger or very active patients as it does not carry the same risk of components wearing and loosening that comes with total shoulder replacement.
Total shoulder replacement: the arthritic joint is completely replaced with an artificial implant consisting of a polished metal ball and a plastic socket. If your bone is in good condition the surgeon may use a press-fit component. However, if the bone is soft, bone cement may be used to hold the components in place.
Reverse shoulder replacement: Conventional shoulder replacement surgery is not suitable for patients with large tears in the rotator cuff who have developed a form of shoulder arthritis called cuff tear arthropathy. For these patients, reverse shoulder replacement is the only definitive surgical treatment. Whereas conventional shoulder replacement mimics the normal anatomy of the shoulder, with a plastic cup fitting into the shoulder socket and a metal ball at the top of the upper arm, in reverse shoulder replacement the metal ball is fitted into the socket and the plastic cup is attached to the upper end of the humerus. Rather than relying on the rotator cuff muscles to move the arm, a reverse total shoulder replacement uses the deltoid muscles. The result is a dramatic reduction in pain from arthritis with a better range of movement for people with cuff tear arthropathy.
Balloon shoulder arthroplasty is another ground-breaking surgical procedure to treat the pain associated with major irreparable rotator cuff tears. It entails inserting a balloon-shaped device above the shoulder joint to create a physical barrier between the bones to reduce pain, improve shoulder function and delay more invasive surgery. The spacer dissolves naturally after around a year.