Surgery

Total Shoulder Arthroplasty

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Total Shoulder Arthroplasty, Shoulder Replacement Surgery, Shoulder Arthroplasty, Reverse Total Shoulder Arthroplasty

  • Definitions
  1. Glenoid and humeral head replacement
  • Indications
  1. Severe Shoulder Osteoarthritis
  2. Shoulder Pain and loss of function refractory to conservative therapy or prior surgery
  3. End-stage rotator cuff Arthropathy
  4. Osteonecrosis
  • Contraindications
  1. Recent infection
  2. Neuropathic joint
  3. Deltoid or rotator cuff complete paralysis
  4. Debilitating comorbid illness
  5. Shoulder Instability that cannot be surgically corrected
  • Efficacy
  1. Most effective and long-lasting procedure for severe Shoulder Arthritis
  1. Arthoplasty performed under general Anesthesia with supplemental Regional Anesthesia in some cases
  2. Minimal blood loss
  1. Glenoid fossa resurfaced with solid polyethylene part
  2. Humeral head and neck replaced with metal prosthesis
  • Procedure
  • Reverse Total Shoulder Arthroplasty
  1. Ball is attached to glenoid and socket to the proximal Humerus (reverses anatomic positions)
  2. Function after reverse arthroplasty may be better than traditional replacement in specific cases
    1. Complicated proximal Humeruse Fracture in older adults
    2. Significant rotator cuff pathology would limit function in traditional replacement
      1. Deltoid Muscle becomes primary in Shoulder movement
  3. Shoulder Dislocations may occur in 4% of patients (esp. Obesity, prior dislocation)
    1. May occur within weeks of surgery (most common)
    2. Delayed dislocation may be due to glenoid bone loss, implant wear, malalignment
    3. Risk of neurovascular injury (esp. Axillary Nerve Injury)
    4. Use standard Shoulder reduction techniques if not contraindicated
      1. Refer to orthopedics after reduction (revision may be needed in up to 45% of cases)
    5. Defer reduction to orthopedics in complicated cases
      1. Periprosthetic Fracture
      2. Acromial Fracture or Scapular Fracture
  4. References
    1. Riveros (2024) Crit Dec Emerg Med 38(12): 20-1
  • Protocol
  • Post-operative Management
  1. Sling used for 3-6 weeks after surgery
  2. Post-operative rehabilitation
    1. Day 1
      1. Start active range of motion of elbow, wrist and hand
      2. Start passive range of motion of Shoulder
    2. Day 21
      1. Start pulley Exercises
    3. Day 35
      1. Start Isometric Exercises
  • References
  1. Edwards (2003) J Shoulder Elbow Surg 12(3):207-13 [PubMed]
  2. Gartsman (2000) J Bone Joint Surg Am 82(1):26-34 [PubMed]
  3. Millet (2008) Am Fam Physician 78(5):605-11 [PubMed]