What Are Partial and Total Shoulder Replacements?
Shoulder replacements, also known as shoulder arthroplasties, involve replacing damaged bone and cartilage in the shoulder joint with metal and plastic components. The shoulder is a meeting of three bones: the humerus (upper arm bone), clavicle (collarbone) and scapula (shoulder blade).
The ball-shaped head of the humerus fits into a relatively flat cavity in the shoulder blade called the glenoid. A ring of cartilage called the labrum surrounds the glenoid, while articular (smooth) cartilage covers the head of the humerus.
In an “anatomic” total shoulder replacement, the humeral head and articular cartilage is replaced with a metal ball, and the glenoid is fitted with a plastic piece. Generally, only the humeral head is replaced in a partial shoulder replacement, also known as a hemiarthroplasty.
Some patients may be better candidates for a “reverse” total shoulder replacement where a metal ball is placed on the socket side and a plastic socket is placed on the humeral side. A reverse shoulder replacement can be a better option for many patients, especially those with rotator cuff tears that cannot be repaired or those who have had prior shoulder replacements that have failed.
Common Reasons for a Shoulder Replacement
About 70,000 shoulder replacements are performed in the U.S. every year. Arthritis—specifically osteoarthritis and rheumatoid arthritis—is a common reason for an anatomic shoulder replacement. Reverse total shoulder replacements are often done for irreparable rotator cuff tears, arthritis combined with a rotator cuff tear, post-traumatic deformities of the shoulder, severe bone deformities, revision of failed shoulder replacements and severe humerus fractures in elderly patients
Candidates for Shoulder Replacement Surgery
Good candidates for shoulder replacement surgery include people who have:
- Moderate to severe pain at rest
- Severe pain that interferes with day-to-day life
- Severely restricted range of motion
- Tried more conservative treatments like anti-inflammatories, corticosteroid injections and activity modification. Physical therapy is often not helpful for patients with shoulder arthritis.
A shoulder arthroplasty of any kind usually takes about one to two hours. There are a number of different shoulder replacement surgeries, each with slightly different uses. They include:
- Total shoulder arthroplasty—The humeral head is replaced with a metal ball and the glenoid is fitted with a plastic socket. This is good for people with cartilage loss, bone spurs and a working rotator cuff.
- Reverse total shoulder arthroplasty—For this joint replacement, the glenoid is fitted with a metal ball and a plastic socket is attached to the humeral head. This option is good for people with severely torn rotator cuffs or more severe shoulder problems.
- Hemiarthroplasty—Only the humeral head is replaced. This is good for people whose glenoid either has enough cartilage or whose glenoid is severely damaged and cannot safely be fitted with an implant. The surgery is often chosen in cases of avascular necrosis, a problem of bone death and cartilage collapse seen mainly on the bimetallic side, often in younger patients with healthy glenoid cartilage.
Patients may be able to go home after the surgery, or they may require a very short hospital stay of a few days. There will be pain after the surgery, which can be controlled with ice, anti-inflammatories or painkillers. Antibiotics will prevent infection at the surgical incision site and within the prosthesis.
The arm will need to be immobilized in a sling for up to six weeks. After about two weeks, patients should be able to drive a car and perform basic tasks like grooming and eating. The surgeon or other staff will provide patients with an exercise program to follow at home. Following this program is crucial to strengthening the arm, regaining range of motion and speeding up the healing process.
Physical therapy often helps in the recovery after shoulder arthroplasty. The surgeon will generally decide when to start physical therapy, usually about two to six weeks after surgery, depending on the procedure.
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