• Total Shoulder Replacement/Arthroplasty

    Total Shoulder Replacement/Arthroplasty

    What is a total shoulder replacement?

    A total shoulder replacement surgery is primarily performed for osteoarthritis or bone degeneration that may occur over time in the shoulder joint. The shoulder joint is one of the most unstable joints in the body. The shoulder joint consists of a ball and socket joint like the hip joint. Unlike the hip, the shoulder lacks intrinsic musculoskeletal stability and is highly dependent upon the surrounding soft tissues (labrum, capsule, ligaments, and rotator cuff) for stability. The shoulder is the second most common site for chronic joint pain next to the knee. Primary glenohumeral osteoarthritis is the most common etiology followed by rotator cuff tear arthropathy, post-traumatic arthritis, avascular necrosis, and rheumatoid arthritis. Onset of osteoarthritis causes the articular cartilage of the shoulder joint to degenerate and eventually the possibility osteophyte formation. This articular cartilage deformation can cause a joint contracture or severely limit the shoulder joint’s range of motion. Rotator cuff involvement is usually spared with osteoarthritis, but degeneration is often associated with rheumatoid arthritis. A total shoulder replacement usually utilizes a metal implant to replace the head of the humerus and the glenoid fossa of the shoulder joint. The goal of anatomic total shoulder replacement is to restore normal bony anatomy and shoulder kinematics while replacing both the humeral and glenoid articular surfaces and is indicated when there is both humeral and glenoid arthritis with an intact and functioning rotator cuff.

     

    Total shoulder Replacement

    What is a reverse total shoulder replacement?

    A reverse total shoulder replacement is different than the usual total shoulder prosthetic involved with degenerative conditions of the shoulder. Patients who have a severely degenerated rotator cuff along with bone deterioration within the shoulder joint are eligible for a reverse total shoulder arthroplasty. The reverse total shoulder prosthesis reverses the orientation of the shoulder joint by replacing the glenoid fossa with a fixed humeral head on a moveable shaft or stem of the humerus and a concave cup. This prosthetic design alters the kinematics of the shoulder joint and enhances the mechanical advantage of the deltoid muscle. The deltoid is the primary elevator of the shoulder joint after this surgery.

     

    Who qualifies for Total Shoulder Replacement?

    • Intractable shoulder pain with conservative measures
    • Severe rotator cuff arthropathy
    • Bone degeneration or osteoporosis of the shoulder joint
    • Some humeral fractures

     

    Rehabilitation of a Total Shoulder Replacement

    Physical therapy of any type of shoulder replacement requires time and consistency with therapy in order to improve a patient’s range of motion, strength, and functional outcomes. Physical Therapy after a total shoulder replacement can last up to 4-6 months depending on the extent of the surgery and how much damage there was to the shoulder itself. Rotator cuff strengthening is a key part of the rehabilitation process for traditional shoulder replacements. Those with reverse total shoulder replacements can expect a rehabilitation program that concentrates on deltoid activation and strengthening.  

    New Patients are Always Welcome!

    The doctors at F.I.T. Muscle & Joint Clinic in Overland Park & Shawnee, Kansas and Lees Summit, Missouri are here to help lessen and relieve shoulder pain and provide the proper rehabilitation after surgery. Do not hesitate; contact us today for leading evidence-based assessments and treatments for your musculoskeletal pain and dysfunction.

     

     

    J Orthop Sports Phys Ther. 2007 Dec;37(12):734-43. doi: 10.2519/jospt.2007.2562. Epub 2007 Aug 28.Rehabilitation following reverse total shoulder arthroplasty. Boudreau S1, Boudreau ED, Higgins LD, Wilcox RB 3rd.