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Shoulder Replacement

by David Saxton, MD

Shoulders can be replaced just like hips or knees can be replaced. Because the shoulder isn't a weight bearing joint (we don't walk on our arms), shoulder replacements are performed much less frequently than for knees and hips.

The primary reason to get a shoulder replacement is arthritis in the shoulder joint itself, which limits the person's ability to move their arm at the shoulder and can cause pain. Some people have arthritis so severe, the bone spurs created by the arthritis prevent them from moving their arms enough to even touch their heads.

When this occurs the patient's options are limited. You can stop moving the shoulder through the motion that hurts. You can take anti-inflammatory medications like Aleve® or Motrin®. For long term use, many people are put on a once a day pill called Mobic® or Celebrex®. When pills aren't strong enough, you can get a cortisone injection into the shoulder joint. This won't fix the arthritis but often covers up the pain. If it works well, you can get a repeat injection every 3 to 4 months. When these treatments fail, it's time to consider a shoulder replacement.

Shoulder replacements come in two different basic types: a traditional shoulder replacement and a reverse shoulder replacement. A traditional shoulder replacement works well for patients with arthritis who still have an intact rotator cuff. In this replacement, the Glenoid (socket) gets a plastic piece cemented over the arthritic bone and the Humeral Head is replaced with a metal ball. This works well for patients who need their shoulders to be comfortable performing daily activities like washing their hair and eating. It is not meant for someone who is working out lifting heavy weights or performs manual labor for a living.

The reverse shoulder replacement is meant for patients with arthritic shoulders who no longer have a rotator cuff. The rotator cuff is a collection of muscles that helps people raise their arms up overhead. If these patients get a traditional shoulder replacement they still won't be able to reach overhead because they no longer have a rotator cuff. In these patients the Glenoid (socket) has a ball to replace the socket and the humeral head gets a cup to match the ball at the socket. This reverses the normal orientation of the ball and socket of the shoulder. By doing this the patient will be able to reach overhead because as the shoulder starts to slip out of position, the lip of the cup at the humeral head catches the bottom of the ball at the socket and hinges around it, without actually being able to drop out of position.

Both surgeries are very successful when performed on the right patient. If you have shoulder pain and wonder if you are a candidate for these procedures, please give us a call. We'd be happy to see you.