Although shoulder replacements are less common than knee or hip replacements, they are just as successful in relieving joint pain. Shoulder replacement surgery replaces the damaged joint with an artificial one that allows patients to enjoy painless motion and resume their regular activities.
Who needs shoulder replacement surgery?
Shoulder replacement surgery is performed to treat degeneration of the ball-and-socket joint of the shoulder. When the cartilaginous surfaces of the ball and socket become rough, they rub against each other rather than glide causing pain, stiffness and swelling. Most patients who elect to undergo shoulder replacement surgery have experienced pain and stiffness for a long time. Many note limitation in their everyday activities, and the associated pain may interfere with sleep. Shoulder replacement surgery is performed to alleviate pain, and improve the range of motion of your shoulder, which also improves your function and the quality or your life.
Shoulder replacement surgery is often performed to treat conditions such as:
- Osteoarthritis, "Bone-on-bone" contact
- Rheumatoid arthritis or inflammatory arthritis
- Rotator cuff tears
- Avascular necrosis
The conservative treatment of osteoarthritis of the shoulder includes activity modification with avoidance of things that you know irritate your shoulder. Traditional over-the-counter anti-inflammatory medication such as Advil (Ibuprofen) or Aleve (Naproxen), or prescription anti-inflammatory medication such as Celebrex may be recommended. The judicious use of periodic cortisone injections can provide temporary relief, but should not exceed more than 3 per calendar year. Physical therapy (PT) may be helpful when arthritis is in early stages. The goals of PT are to maintain range of motion and strengthen the shoulder muscles. However, in more advanced cases PT tends to be less effective and may irritate the joint by rubbing bone on bone potentially making the shoulder hurt more. There recently has been interest in the ortho-biological treatment of shoulder arthritis using platelet-rich plasma (PRP/ACP). Although the rationale for this treatment seems to make sense, it has not been scientifically proven. If you are interested in PRP/ACP, please ask for details at your office visit.
Shoulder Replacement Surgery
When conservative measures fail, shoulder replacement surgery may be recommended. The procedure involves removing the damaged surfaces of the joint, and replacing them with an artificial joint. The procedure is performed through an incision on the front of the shoulder. The shoulder replacement that Dr. Guerra uses is manufactured by Arthrex where he serves on the shoulder replacement design team.
The Arthrex shoulder is the third generation of shoulder replacements and incorporates all of the latest features and is the most anatomic replacement currently available. The humeral component (ball) is made out of titanium and cobalt-chrome alloy which is highly polished. The glenoid (socket) is cemented into place and is made of a special, highly durable plastic (polyethylene).
Dr. Guerra has performed the most shoulder replacements in Southwest Florida making him one of the most experienced surgeons in Florida. He performs the surgery at North Naples Hospital. The surgical procedure takes about two hours to perform and is usually done under general anesthesia with a supplemental regional block. A regional block is performed by a board-certified anesthesiologist. The anesthesiologist places numbing medicine around the nerves that go to the shoulder under ultrasound guidance. This significantly reduces the pain after surgery. Patients usually stay in the hospital for one or two days.
Physical therapy starts the day after surgery, and continues as an outpatient upon discharge. Physical therapy is a key component in maximizing the outcome and restoring function to the joint after surgery. Generally, patients perform formal physical therapy 2-3 times per week for 6 weeks after discharge. Patients are encouraged to perform simple activities such as eating, dressing and grooming within a few days of the surgery. Most patients are able to return to all of their regular activities after two to three months. We allow and encourage our patients to participate in light sports such as golf at 2-3 months, and tennis at 3- 4 months.
Risks & Benefits
While shoulder replacement surgery has been performed successfully for many years, there are certain risks involved with any surgical procedure. Some of these risks may include infection, blood clots, nerve injury, instability and loosening of the implant. These risks are considered rare, and most patients experience symptom relief and improved range of motion after this procedure. Many thousands of patients have experienced an improved quality of life after shoulder replacement surgery.