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Shoulder Replacement

Shoulder Replacement Surgery

If nonoperative treatments fail, shoulder replacement surgery may be needed. Shoulder replacements are usually done to relieve pain.

There are several different types of shoulder replacements. The usual total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

The components come in various sizes. If the bone is of good quality, your surgeon may choose to use a non-cemented or press-fit humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid component is implanted with bone cement. Implantation of a glenoid component is not advised if:

The glenoid has good cartilage.
The glenoid bone is severely deficient.
The rotator cuff tendons are irreparably torn.
Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Depending on the condition of the shoulder, your surgeon may replace only the ball. Sometimes, this decision is made in the operating room at the time of the surgery. Some surgeons replace the ball when it is severely fractured and the socket is normal.

Another type of shoulder replacement is called reverse total shoulder replacement. This surgery was developed in Europe in the 1980s. It was approved by the Food and Drug Administration (FDA) for use in the United States in 2004. Reverse total shoulder replacement is used for people who have:

Completely torn rotator cuffs and
The effects of severe arthritis (cuff tear arthropathy) or
Had a previous shoulder replacement that failed
For these individuals, a conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle. Not being unable to lift one's arm away from the side can be severely debilitating. In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

Shoulder replacement surgery is highly technical. It should be performed by a surgical team with experience in this procedure. Each case is individual. Your surgeon will evaluate your situation carefully before making any decisions. Do not hesitate to ask what type of implant will be used in your situation. Ask why that choice is right for you.

Before surgery, patients see their internist or family practice physician for a preoperative medical evaluation. Cardiac patients should see their cardiologist as well. Two weeks before surgery, you should stop taking the following medications that thin the blood and can lead to excessive bleeding during surgery:

Nonsteroidal anti-inflammatory medications (aspirin and ibuprofen such as Motrin and Advil)
Most arthritis medications
The surgery is performed on an inpatient basis. Most patients are discharged from the hospital on the second or third day after the operation.

*Information on this page is from the American Academy of Orthopaedic Surgeons.

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