Shoulder Total Joint Replacement

by Denver T. Stanfield, MD

Shoulder total joint replacement or "glenohumeral arthroplasty" is a procedure that was first performed in 1893. The procedure of glenohumeral arthroplasty involves replacement of the ball and socket joint of the shoulder. The socket of the shoulder is called the "glenoid" and the ball of the upper arm is called the "humeral head". The surgical procedure therefore involves a resurfacing or replacement of the glenoid and humeral head with artificial components. Since the first procedure in 1893 the surgical technique has steadily evolved along with the understanding of the mechanics and operation of the shoulder. In the hands of an experienced shoulder surgeon, this technically demanding procedure can provide substantial improvements in patient comfort and function.

Glenohumeral arthroplasty is a procedure which should be considered in shoulders in which destruction of the glenohumeral joint surface has led to intolerable pain and loss of function. There are multiple potential causes for this joint destruction which include degenerative osteoarthritis, avascular necrosis, rheumatoid arthritis, joint arthritis following previous trauma, and several other potential causes. Depending upon the cause of the shoulder degeneration, the status of the surrounding muscles and tendons, and the condition of the bone the procedure may involve replacement of only the humeral head or both the humeral head and the glenoid. Several factors which lessen the chances of a good result include the history of a previous joint infection, muscle or tendon detects within the shoulder from a previous injury, previous shoulder fractures which have healed in malposition, rotator cuff tear, poor nutrition, and poor patient motivation.

Glenohumeral arthroplasty is routinely a very successful procedure although certain potential complications do exist. The patient should be familiar with the risks of anesthesia and the potential surgical complications which include infection, loosening or failure of the artificial component, fracture, neurovascular injury, limited shoulder function, persistent pain, and the possible need for additional surgical procedures.

It has long been established that patients who are well informed and highly motivated before their shoulder surgery are more likely to obtain an optimal result. The patient must understand the need to participate actively in the rehabilitation program for up to one year following the surgical procedure. Glenohumeral arthroplasty is not recommended for patients who intend to return to occupational or recreational activities that apply sudden impact or heavy loads to the shoulder joint. Following a glenohumeral arthroplasty the patient will experience a temporary loss of functional independence for activities of daily living, personal needs, shopping, and transportation. The assistance of relatives or friends is usually necessary until independence is regained.

Because glenohumeral arthroplasty is an elective procedure, it is extremely important that the medical condition of the patient be optimized. For most patients it is recommended that a history and physical be performed by their Family Medicine or Internal Medicine Physician prior to the surgical procedure. This will allow any cardiovascular, pulmonary, metabolic or infectious problems to be managed before the surgical procedure is performed. Lastly, the post-operative management of the shoulder cannot be over emphasized. A superbly performed surgical technique alone cannot provide a good result. The surgical procedure must be followed with a well designed post-operative rehabilitation program. This program of rehabilitation involves the use of several small pieces of exercise aides. Often the use of a continuous passive motion (CPM) device is also employed. In optimal circumstances, glenonhumeral arthroplasty can yield a most rewarding functional result for the patient.

Most surgeons have reported a high degree of patient satisfaction and pain relief. The differences in results are mainly attributable to differences in functional recovery. When proper surgical techniques are followed by appropriate rehabilitation in a cooperative and motivated patient, the results can be quite rewarding.