The first, albeit unsuccessful, attempt to replace part of a joint damaged by disease with a prosthetic component took place around 130 years ago. However, it is just a little under 70 years since this somewhat radical concept became a viable proposition. This type of surgery is known today as arthroplasty, and it is one that most people will tend to associate with either the hip or the knee joint. However, although perhaps not as widely known, ankle, wrist, elbow, and shoulder replacements are equally likely to feature on the theatre lists of some specialised orthopaedic departments.
The reasons surgery on these joints is often necessary are similar to those that commonly lead to a need for knee or hip arthroplasty. Some injury or disease process will be causing pain and perhaps limiting the use of the affected joint. Just as with knee and hip problems, the most common cause is osteoarthritis. This condition leads to the progressive erosion of the cartilage layer that protects the articulating surfaces. Among candidates for a shoulder replacement, the affected surfaces are the head of the humerus and the glenoid cavity. Together, these act as a ball and socket.
When Might Surgery be Necessary?
Again, as with the hip and knee joints, either one or both of these protective coatings may be sufficiently damaged to warrant surgical attention. Injuries to this joint are also quite common, especially among those who enjoy certain sports and tend to “give it their all”. Tennis players, cricketers, golfers, and weightlifters are among those who frequently sustain injuries to this joint and become candidates for a shoulder replacement.
Unlike the osteoarthritis sufferers who are generally more elderly, sporting injuries are apt to occur among people of all ages. Consequently, many of those who will require this procedure fall in the twenty- to forty-year range. Other possible reasons for this type of joint surgery include complex fractures, severe arthritis, impairment of the blood supply to bones in the region and a torn rotator cuff – the collection of muscles and tendons that keeps the head of the humerus firmly positioned in its socket.
Although shoulder replacements are performed far less frequently than surgery to replace a hip or knee joint, approximately 53 000 of these procedures are carried out in the United States every year. While such extreme measures may not always be necessary, there are clear indications of when shoulder arthroplasty may be the best option.
When treatment with analgesics, physiotherapy and steroid injections no longer provides relief, the pain makes it hard to sleep, and reduced mobility makes it hard to perform everyday tasks, it’s time to consider a shoulder replacement.
What Will the Surgery Involve?
A couple of weeks beforehand, it will be necessary to conduct a thorough physical examination to ensure a patient is sufficiently fit to undergo surgery. This may include X-rays, alternative imaging options or arthroscopy to examine the joint directly. Medications such as non-steroidal anti-inflammatories that could thin the blood and promote excessive bleeding will also need to be discontinued at around the same time.
The operation can be conducted under general or local anaesthesia. The latter option will leave the patient awake throughout the shoulder replacement but sedated. Based on the arthroscopic findings, the surgeon will determine how to proceed and whether just the humeral head, the glenoid cavity or both will require attention.
In the conventional approach, the surgeon will make a single incision to expose the joint, remove the damaged head of the humerus and replace it with a metal prosthesis, and line the glenoid cavity with plastic if required. Patients can normally go home after 2 to 3 days. With physiotherapy, some pain medication and regular follow-ups, most people who have a shoulder replacement should be able to start driving again within 6 to 8 weeks.