Total Shoulder Replacement

Who is a Candidate for Total Shoulder Replacement?

A candidate for total shoulder replacement is typically someone who experiences severe shoulder pain and stiffness that limits daily activities and doesn’t respond to other treatments. Common conditions that might lead to this surgery include:

Osteoarthritis: Degeneration of joint cartilage and underlying bone.
Rheumatoid Arthritis: An autoimmune condition causing inflammation in the joints.
Post-Traumatic Arthritis: Arthritis resulting from a serious shoulder injury.
Rotator Cuff Tear Arthropathy: Severe arthritis with a large, irreparable rotator cuff tear.
Avascular Necrosis: Loss of bone tissue due to reduced blood flow.

Patients who haven’t found relief through medications, physical therapy, or less invasive procedures may consider total shoulder replacement. The decision is usually based on the level of pain, disability, and the impact on the patient’s quality of life.

What Does the Surgery Involve and what is the procedure of TSR ?

Total shoulder replacement surgery involves removing the damaged parts of the shoulder joint and replacing them with artificial components to restore function and relieve pain. The procedure typically includes replacing the head of the humerus (upper arm bone) with a metal ball and resurfacing the socket (glenoid) with a plastic component.

The procedure of total shoulder replacement (TSR) generally follows these steps:

Preparation and Anesthesia: The patient is given anesthesia, either general (putting the patient to sleep) or regional (numbing the arm and shoulder area).
Incision: The surgeon makes an incision over the shoulder to access the joint. This incision can vary in length depending on the specific technique used.
Removal of Damaged Bone and Cartilage: The surgeon removes the damaged cartilage and bone from the humeral head and the glenoid socket.
Implantation: The surgeon inserts a metal ball attached to a stem into the humerus. The stem is often cemented into place. The glenoid cavity is resurfaced with a plastic socket, which may be cemented or press-fitted.
Closure: The surgeon closes the incision with sutures or staples and covers it with a sterile bandage.
Recovery: The patient is taken to a recovery area for monitoring. Post-surgery, the patient begins a rehabilitation program, including physical therapy, to regain strength and mobility in the shoulder.

What is the difference between Total Shoulderreplacement & Partial ShoulderReplacement ?

The main difference between total shoulder replacement and partial shoulder replacement lies in the extent of the joint replacement and the components used:

Total Shoulder Replacement (TSR):
- Scope: Involves replacing both the ball (head of the humerus) and the socket (glenoid) of the shoulder joint.
- Components: A metal ball attached to a stem is inserted into the humerus, and a plastic socket is attached to the glenoid.
- Indication: Typically recommended for patients with severe arthritis, extensive joint damage, or conditions affecting both the humeral head and the glenoid.
Partial Shoulder Replacement (PSR):
- Scope: Involves replacing only the damaged part of the shoulder joint, usually just the ball of the humerus.
- Components: A metal ball and stem are implanted into the humerus, while the natural glenoid socket is left intact.
- Indication: Suitable for patients with isolated damage to the humeral head, such as fractures or localized arthritis, with a relatively healthy glenoid.

The choice between total and partial shoulder replacement depends on the extent of the damage to the shoulder joint and the specific condition being treated. An orthopedic surgeon will assess the patient’s condition and recommend the most appropriate procedure.

What is the cost of Total Shoulder Replacement ?

The cost of total shoulder replacement can vary widely depending on several factors, including the country and region where the surgery is performed, the specific hospital or surgical center, the surgeon’s fees, and any additional medical expenses.This estimate generally includes the surgeon’s fee, hospital stay, anesthesia, pre-surgery consultations, and post-surgery physical therapy. Insurance coverage can significantly affect the out-of-pocket cost for patients, so it is important to check with your insurance provider for specific details regarding coverage and potential expenses.

What are the types of implants for TSR ?

The Three types of implants for total shoulder replacement (TSR) vary based on the materials used, the design, and the fixation method. Here are the main types:

Anatomic Shoulder Replacement: Mimics the natural anatomy of the shoulder. A metal ball replaces the humeral head, and a plastic socket replaces the glenoid. This type is used when both parts of the shoulder joint need replacement, and the rotator cuff is intact.
Reverse Shoulder Replacement: The positions of the ball and socket are switched, with the metal ball placed on the glenoid and the plastic socket on the humerus. This design is used primarily in cases where the rotator cuff is damaged or torn, as it relies on different muscles to move the arm.
Stemless shoulder replacement: is a type of shoulder arthroplasty where the humeral component (the part that replaces the ball of the shoulder joint) does not include a long stem that extends into the humerus (upper arm bone). Instead, it features a shorter, stemless design that is anchored into the humeral head.

Can Both Shoulders Be Replaced at the Same Time?

Yes, both shoulders can be replaced at the same time in a procedure known as bilateral shoulder replacement. However, this is less common than bilateral knee replacements due to the following considerations:

Complexity and Duration: Replacing both shoulders in a single surgery is complex and requires a longer surgical time, which can increase the risk of complications.
Recovery and Rehabilitation: Recovery from bilateral shoulder replacement can be challenging. Patients would need to manage their daily activities without the full use of both arms during the initial recovery period, making tasks such as dressing, eating, and personal hygiene more difficult.
Staged Approach: More often, shoulder replacements are done in stages, with the surgeries spaced several months apart. This allows the first shoulder to heal and regain strength before the second surgery, making the overall recovery process more manageable.
Health and Fitness: The decision to perform bilateral shoulder replacement at the same time depends on the patient’s overall health, fitness level, and ability to withstand a prolonged surgery and recovery period.

How Long Does a Shoulder Replacement Last?

The lifespan of a shoulder replacement can vary depending on various factors, including the patient’s age, activity level, the type of implant used, and the underlying condition being treated. On average, a shoulder replacement can last between 15 to 20 years or more. Advances in surgical techniques and implant materials have improved the longevity of shoulder replacements, and many patients experience functional and pain-free use of their artificial shoulder for two decades or longer. However, factors such as excessive wear, implant loosening, or bone loss over time may necessitate revision surgery to replace or repair the implant. Regular follow-up with an orthopedic surgeon and adherence to post-operative care and rehabilitation guidelines can help maximize the lifespan of a shoulder replacement.

Total Shoulder Replacement Surgery In Ahmedabad