Who Needs Shoulder Replacement Surgery?
Learn about the common conditions, such as arthritis and rotator cuff arthropathy, that may require shoulder replacement surgery.
Reasons for Shoulder Replacement Surgery
Most patients who undergo shoulder replacement surgery have experienced shoulder pain for a long time, having developed pain that limits daily motion and may even interfere with their sleep. Shoulder stiffness may also have an impact on performing everyday activities. In a diseased shoulder, inflammation causes pain and stiffness. Osteoarthritis, rheumatoid arthritis, rotator cuff tears (arthropathy), avascular necrosis, and fractures are the most common reasons for a shoulder replacement surgery.
Osteoarthritis
Also known as “wear-and-tear” arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, meaning that it usually affects the same joint on both sides of the body. Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue, such as cartilage and ligaments, and soften bone.
Rotator Cuff Tear Arthropathy
Arthritis can also develop after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus can now move upward and rub against the acromion. These abnormal movements can damage the surfaces of the bones, causing arthritis to develop. The combination of a large rotator cuff tear and advanced arthritis can cause severe pain and weakness, which can lead to not being able to lift the arm from the side. This is known at pseudoparalysis.
Avascular Necrosis
Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Bone cells die without blood supply, so AVN can ultimately lead to the destruction of the shoulder joint and arthritis. Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, which damages the cartilage covering the bone and leads to arthritis. At first, AVN affects only the head of the humerus, but as it progresses, the collapsed head of the humerus can damage the glenoid socket.
Fracture
Complex proximal humeral fractures are becoming more common in the older population as we are living longer. Nonoperative management used to be the preferred treatment; however, with the advent of newer, safer technology, surgical interventions to help restore function and provide pain relief now exist. Reverse total shoulder replacement for fracture has improved the treatment of complex proximal humerus fractures, especially in older patients with osteoporotic bone.1