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Shoulder Replacement Surgery

Michael Stowell, MD

Shoulder pain is not just for major league baseball players and professional golfers. At some point, most people experience a shoulder problem. Yet according to orthopedic surgeon Michael Stowell, MD, shoulder replacements are not as common as hip and knee replacement surgeries. “People don’t walk on their shoulders,” said Stowell. In fact, the shoulder joint is not a weight-bearing joint; therefore it carries less load and has less potential for arthritis.

However, the shoulder is a contradictory joint: it offers the greatest range of motion of any joint in the body, yet it is fairly unstable. Visualize a golf ball sitting on a golf tee—that is your shoulder joint. It can be injured because the ball of the upper arm is larger than the socket that holds it. To remain stable, the shoulder is anchored by muscles, ligaments, and tendons.

A shoulder resurfacing

Bursitis, rotator cuff tears, and instability (when the shoulder dislocates frequently) are common reasons for shoulder procedures. “Arthritic pain is the minority,” said Dr. Stowell. Orthopedic surgeon Ralph Salvagno, MD, finds that people with previous shoulder injuries, such as repetitive falls or dislocations, are more likely to suffer from shoulder pain.

“The first step is to meet with your orthopedic surgeon so he can determine the source of your pain,” advised Dr. Stowell. Along with a thorough physical exam, the surgeon will use an MRI, CT scan, or x-ray to determine the extent of damage. Orthopedic surgeons and patients have more options today than ten years ago. “Shoulder surgeries are becoming more common because of advancing technologies such as shoulder resurfacing and reverse shoulder replacement,” explained Dr. Salvagno.

Surgical options

A reverse shoulder replacement

For patients with minimal arthritis and an intact rotator cuff, shoulder resurfacing is a less invasive procedure. An orthopedic surgeon reconditions or smoothes the humeral head and caps it off with a metal prosthesis. The surgery takes about one hour and requires a hospital stay of one to two days.

A newer shoulder procedure called a reverse shoulder replacement uses a ball-and-socket prosthesis. Instead of the ball attaching to the humerus bone, it is implanted into the socket (scapula). This new arrangement substitutes the deltoid muscle for the rotator cuff. For people with a non-reparable rotator tear and severe arthritis, the surgery can alleviate pain and increase range of motion. “Five to seven years ago, they would have had to live with the pain,” commented Dr. Stowell.

	A total shoulder joint replacement

Total shoulder replacement surgery has been performed since the 1950s. Patients with bone-on-bone osteoarthritis and an intact rotator cuff are candidates for this conventional procedure. The surgery involves replacing the ball of the humerus and the socket of the scapula with a metal and plastic prosthesis. A patient can expect surgery to take one to two hours, and the hospital stay to be for three days or less. Rehabilitation can take up to eight weeks with limitations on driving and lifting, but a new shoulder joint can last as long as fifteen years.

With any shoulder surgery, heavy labor and lifting post-treatment are strictly off-limits. “If that’s a component of your job, then we have a discussion about finding a different career,” stated Dr. Stowell. But according to both doctors, orthopedic advancements are on the horizon. Resurfacing both sides of the joint versus replacing the joints may be an option for younger adults. For patients with certain traumatic shoulder injuries, surgeons can now use a cap to replace the damaged part of the shoulder. With an active and aging population, doing more with less downtime is welcome news.