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Total Shoulder Replacement

Total Shoulder Replacement

Advances in shoulder replacement surgery over the past two decade have resulted in highly successful outcomes for patients suffering from shoulder arthritis. First developed by Dr. Charles Neer in the 1950’s and initially introduced as a “monoblock” (all-in-one) design, modern implants have improved to provide modularity (different sizes and separate parts) allowing the surgeon more options to better match the patient’s anatomy during surgery. Combined with better instruments and improved surgical techniques, modern shoulder replacement surgery has demonstrated clinical success rates upwards to 95% with regard to patient satisfaction and improvement in function.1 For those patients suffering with shoulder arthritis that have failed all conservative measures (injections, rest, anti-inflammatories, etc.) surgery can effectively and predictively restore function, alleviate pain, and improve one’s quality of life.

Shoulder replacement surgery is a quality of life procedure, therefore, the impact that the arthritis has on one’s happiness should be one of the greatest factors in deciding on whether to proceed or not. For every individual this may vary. Typically, when the pain begins to overtake one’s ability to enjoy life or greatly hinders one’s ability to care for themselves, then shoulder replacement should be strongly considered. This decision can often times be very scary and impacted greatly by anecdotal accounts of friends and family members. Fortunately, shoulder replacement surgery has been shown to be safer than hip or knee replacement surgery with a 50% less complication risk based on a recent study published out of John’s Hopkins.2 Complications are also 50% less in surgeons performing a high volume of shoulder replacement surgeries annually.3, 4 The average orthopedist performs less than 10 replacements per year compared to a “high volume” surgeon that performs greater than 50 per year. Patients are encouraged, therefore, to seek out a shoulder replacement specialist with preferably fellowship training to discuss and identify if replacement surgery is right for them. Do not be afraid to confront your surgeon on their own experience with shoulder replacement surgery and also verify that both sides of the joint will be replaced at the time of surgery as the results clearly support total replacement versus partial replacement surgery!

Following shoulder replacement surgery, patients are often able to return to previous activities with improved functional abilities. In fact, over 70% of patients following surgery noted an improvement in their ability to participate in tennis, golf or swimming and 89% of patients were able to return to their preoperative sporting activity.5, 6 While recovery times may vary, the average patient is able to resume these types of activities by 4 months postoperatively. In one study looking at golf in particular, the average time to be able to play a full round was 4.5 months, with 75% of patients returning to their preoperative handicap and an average improvement of 5 strokes following surgery.7 Obviously, as with any other replacement surgery, some degree of activity modification is strongly advised to improve the longevity of your replacement. For shoulder replacement surgery this typically pertains to an overhead weight restriction (nothing greater than 20 pounds) and lifetime avoidance of contact sports. This does not mean that you can’t occasionally lift more than 20 pounds, but doing this repetitively has a higher probability of wearing your parts out sooner.

References:

  1. Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg. 2002 Mar-Apr;11(2): 130-5.
  2. Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG.  Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes. Clin Orthop Relat Res. 2007 Feb; 455:183-9.
  3. Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2003 Dec;85-A(12):2318-24.
  4. Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004 Mar;86-A(3):496-505.
  5. McCarty EC, Marx RG, Maerz D, Altchek D, Warren RF. Sports participation after shoulder replacement surgery. Am J Sports Med 2008;36:1577-81.
  6. Schumann K, Flury MP, Schwyzer H, Simmen BR, Drerup S, Goldhahn J. Sports activity after anatomical total shoulder arthroplasty. Am J Sports Med 2010; 38:2097-105.
  7. Jensen KL, Rockwood CA Jr. Shoulder arthroplasty in recreational golfers. J Shoulder Elbow Surg 1998; 7:362-7.

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