Who Needs a Shoulder Replacement?
The shoulder consists of the clavicle, scapula, and humerus bones. The top of the humerus (upper arm) and edge of the scapula (glenoid or socket) form the joint. The complex relationship between the bone and soft tissue allow a greater range of motion compared to other joints in the body. When arthritis becomes severe in the shoulder, or the rotator cuff tendons become ineffective, the joint may need to be replaced. Typically one would notice limited motion, decreased strength, and increasing pain in the shoulder.
What is a Total Shoulder Replacement (TSA)?
When arthritis affects the ball-and-socket joint in the shoulder, and the bones rub against each other, causing pain, shoulder replacement may be a good option. The most common diagnosis is osteoarthritis, but other inflammatory arthropathies, or even avascular necrosis could be a reason to have the surgery.
In a TSA, the entire joint is replaced; a metal stem and ball is placed into the humerus, and a special plastic socket is placed into the glenoid. Usually a small amount of bone cement is needed as well.
What is a Reverse Total Shoulder Replacement (RTSA)?
For patients who have old rotator cuff tears that are not repairable, or who have shoulder arthritis and prior rotator cuff tears, the RTSA may be the better option. The RTSA can also be used to treat failed TSA, or poor-healing of proximal humerus fractures as well.
The procedure is very similar to the TSA, but the components are shaped differently. Basically the ball and socket side are reversed, hence the name. A ball component is screwed onto the socket side, and a metal stem with a cup is placed into the humerus.
How Painful is the Surgery? What Can I Expect After Surgery?
Though many have expectations of a horrible recovery, the reality is that this a very reasonable recovery. Most patients can successfully undergo the surgery and require very little pain medication following. A nerve block is typically performed in the hospital, which decreases the need for narcotic pain medications. Today most patients use just Tylenol and an anti-inflammatory medication following their replacement.
Depending on the specific procedure, physical therapy starts immediately and may continue for up to 3 or more months. Patients will usually use a sling for 2-6 weeks, and it can be up to 6 months or more before they have full function with the arm. In general though, the pain relief is fairly immediate.