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I Have Bad Arthritis In The Shoulder But I'm Afraid Of Surgery... What Should I Do?

Dec 2, 2007
Joint replacement surgery for arthritis has become commonplace nowadays when it comes to areas such as hips or knees.

However, there is still the notion that shoulder replacement is difficult and not very successful. It's something to consider only as the very last resort... and even then avoid it if possible. Why is this the case?

One reason is that shoulder replacement is not commonly done. Only about a tenth as many shoulder replacements are done as hip or knee replacements. However, new data from a Johns Hopkins study has demonstrated that while less commonly performed, shoulder replacement actually has fewer complications and shorter hospital stays than either knee or hip replacement.

Shoulder replacements are less common than knee or hip replacement for three major reasons.

The first is that the most common form of arthritis, osteoarthritis- is a disease of weight-bearing joints and the shoulder is not a weight-bearing joint.

Also, many people don't realize shoulder replacement is an option or they may lack access to surgeons who can perform shoulder replacement surgery because it is such a specialized procedure.

Finally, many physicians have not been exposed to the excellent results that can be achieved, so they are often reluctant to advise it for their patients.

As with all joint replacement operations, the single biggest determinant of success is the skill and experience of the surgeon.

This is a particularly complex surgery, so it is mandatory to find a highly skilled surgeon at a major medical center, particularly a center specializing in orthopedic surgery, where a large number of shoulder replacements are done.

So if you're a patient with arthritis when do you know you might be a candidate for shoulder replacement? If you're experiencing significant pain due to your arthritis that is disabling or interfering with sleep, that's an indication. Also, if you are having difficulty with daily functioning as a result of arthritis in the shoulder, that would be another indicator that you should at least look into it.

While shoulder arthritis is generally a condition that occurs in older people, the patient must otherwise be healthy enough to undergo the surgical procedure.

Shoulder prostheses last an average of 15 to 20 years so if possible, it's best to delay the surgery until at least the age of 60.

As with other replacement procedures, a revision operation- a replacement of a replacement is a difficult, risky, and complex procedure. Patients under the age of 60 might want to consider lesser options before moving onto shoulder replacement.

Shoulder fusion is another procedure that can be considered. While pain is ameliorated, function of the shoulder is markedly restricted so it's not an option for many patients.

The reason total shoulder replacement is such a challenging operation is that it involves removing the head of the humerus (the top of the upper arm bone) and replacing it with a new prosthetic metal ball. Then, a resurfacing of the glenoid (shoulder socket) is done by by attaching a second saucer-shaped plastic component to the shoulder blade.

Since the shoulder is a smaller and more complex joint than the knee or hip, it is more difficult to place the prosthesis perfectly. Getting to the shoulder joint is made more difficult because of the many nerves, tendons and blood vessels in the area.

Also, the anatomy of the shoulder varies a lot from person to person so many times standardized parts don't fit well. Placement of the implant is very demanding from a surgical viewpoint. Done correctly, shoulder replacement results in a well-functioning shoulder with a durable implant.

Also, and often most importantly, the operation eliminates the arthritis pain.

After the procedure, patients can begin to move their shoulder right away. They should remain in the hospital at least two days though. Several months of physical therapy are necessary to gain full functioning and range of motion in the shoulder.

Most patients can raise their arm by six weeks and resume full activities after three or four months. Patients experience the most dramatic improvement in the first four months. However, they will still make progress over the next year.

They often can return to their previous activities. However, surgeons caution patients that excessive overuse of the joint will wear it out faster.

So... shoulder replacement surgery can be added to the growing number of treatment options available for people with shoulder arthritis that has failed to respond to more conservative measures.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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