As the cartilage continues to deteriorate the joint will become increasingly stiff, inflamed and painful. If conservative measures such as physical therapy, anti-inflammatory medication and activity modifications fail to provide enough relief, total shoulder replacement is the procedure of choice. One prominent symptom that drives patients to act is night pain that interferes with sleep. Night pain is incredibly common for shoulder arthritis.
Other conditions that can result in cartilage destruction include inflammatory arthritis such as rheumatoid arthritis. In this condition, uncontrolled inflammation destroys the cartilage and results in bone on bone in the shoulder joint. Unlike degenerative arthritis, inflammatory arthritis affected shoulders do not develop the bone spurs that we see in degenerative arthritis. When conservative measures fail to provide adequate relief of shoulder pain, total shoulder replacement is performed with great success in terms of relief of pain and improvement in function.
Avascular necrosis is a disease in which there is a temporary or permanent loss of blood supply to the bone. A number of conditions, including long- term use of steroids or alcohol, a traumatic injury, rheumatoid arthritis or unhealed fractures can cause the blood supply to the bone to be cut off. As the bone dies, it collapses and results in a joint that is not congrous. Although avascular necrosis can happen in any bone, it usually affects the ends of long bones such as the humerus. When this happens, the shoulder becomes painful and movement becomes limited.
Proximal Humerus Fractures
The upper arm can fracture for a variety of reasons. Proximal humerus fractures are typically caused by trauma-related injuries such as a fall, but become more common in persons around the average age of 60 as they become more prone to osteoporosis. The proximal humerus includes four parts: the articulating surface, the greater and lesser tuberosity, and the humeral shaft. When complex proximal humerus fractures occur, they tend to break off into three or four parts in consistent patterns around the ball-and-socket joint. Fractures are the most severe injuries to the upper humerus and can be difficult to treat. These fractures can often be treated without surgery, but severe fractures often require surgery to repair with plates and screws. However, the proximal humerus is often compared to Humpty Dumpty because the bone is very soft with a very thin shell. This can make it very difficult if not impossible to repair. In these circumstances, patients are better treated with a total shoulder replacement, and most often a Reverse Total Shoulder (see below).
Total Shoulder Replacement
The shoulder is the 3rd most common joint to undergo replacement surgery. While there are approximately 50,000 shoulder replacements performed annually in the US, there are approximately 900,000 hip and knee replacements performed. Because shoulder replacements are relatively uncommon, there are not a lot of surgeons who perform a large number of shoulder replacements. Therefore, it is recommended that you seek out someone who specializes in this procedure.
You should consider a total shoulder replacement if your pain is not controlled with conservative treatments or you have significant functional limitations that are affecting your quality of life. Total shoulder replacement is a wonderful procedure when performed well, and you can expect to have significant relief of pain and improvements in function.
Primary vs. Reverse Total Shoulder Replacement
There are 2 types of shoulder replacements that can be performed, primary (anatomic) shoulder replacement or reverse total shoulder replacement. In primary TSA, the ball and socket are replaced as they are present in your natural shoulder. In reverse TSA, the ball is placed on your socket and the socket is placed on your ball side of the joint.