Shoulder replacement surgery is needed less frequently than hip and knee replacement, but it is still a very effective option for patients with severe shoulder arthritis that affects everyday life.
Dr. Adam Whatley is a board certified orthopaedic surgeon who has been in practice for over 10 years. He has had extensive experience with shoulder replacement surgery since his fellowship at Brigham and Women’s Hospital, where he trained with Dr. Laurence Higgins, a well-respected shoulder surgeon. Unless a patient has a severe fracture that requires a shoulder replacement to restore stability and function, Dr. Whatley believes that patients who qualify for shoulder replacement surgery should proceed only when they are ready. He will not push a patient to have shoulder replacement unless it is medically necessary.
Candidates for Shoulder Replacement
Unless a patient has a severe shoulder fracture, shoulder replacement surgery is typically elective. Dr. Whatley does not push his patients into surgery, and believes in shared decision-making. He is here to provide his opinion as an experienced orthopaedic surgeon and advise on options if and when a patient is ready for surgery.
When considering shoulder replacement, the most important question to ask yourself is “Does this affect my everyday life?” If your quality of life is suffering due to pain and decreased function in your shoulder, shoulder replacement may relieve or improve those symptoms.
Patients typically elect to have shoulder replacement surgery for the following reasons:
- Chronic shoulder pain limits daily activities
- Shoulder pain makes it difficult to sleep at night
- The shoulder is weak and/or has limited range of motion
- They have a large rotator cuff tear that cannot be repaired, or arthritis that has developed as a result of an old rotator cuff injury
Shoulder Replacement Procedure
Dr. Whatley offers two types of shoulder replacement procedures, which he recommends based on the underlying cause of the patient’s shoulder pain.
Total Shoulder Replacement (Anatomic Shoulder Replacement)
A standard or anatomic total shoulder replacement is done if a patient has severe shoulder arthritis, but the rotator cuff is still in good shape. The shoulder is a “ball and socket” joint, meaning that the ball-shaped upper end of the humerus (upper arm bone) fits into a socket (called a glenoid) in the shoulder blade. This structure allows the shoulder to have greater range of motion than a hinge-type joint like the knees and elbows.
During a standard total shoulder replacement, Dr. Whatley removes the damaged cartilage surface of the shoulder joint, along with the ball-shaped end of the humerus. He then replaces the ball portion of the joint with a stemmed metal ball implant, with the stem inserted into the humerus. The shoulder socket is lined with a cup-like plastic implant, which the ball implant fits into. These components allow the shoulder to glide smoothly and function much like an anatomic shoulder.
Reverse Total Shoulder Replacement
The rotator cuff is a key component in the ability to lift and rotate the shoulder. However, if a patient has a completely torn rotator cuff, or an old rotator cuff injury that led to shoulder weakness and arthritis, the rotator cuff will not be able to support an anatomic shoulder replacement. For these patients, a reverse total shoulder replacement will allow for better shoulder function and range of motion.
With a reverse total shoulder replacement, Dr. Whatley removes the damaged cartilage and the ball-shaped bone at the end of the humerus, just as he does with an anatomic shoulder replacement. However, instead of a stemmed ball implant, a plastic-lined metal cup with a stem is inserted into the upper arm bone. A metal ball implant is then screwed into the shoulder socket, essentially reversing the mechanics of the shoulder. Reversing the placement of the joint components allows the shoulder to rely on the deltoid muscle to lift and rotate the arm, rather than the damaged rotator cuff.
Recovering from Shoulder Replacement
Following shoulder replacement surgery, Dr. Whatley’s patients stay at the hospital overnight for observation. Upon returning home, patients begin working with physical therapy. With shoulder replacement surgery, patients have to be careful to protect the subscapularis, the tendon at the front of the shoulder, during the initial recovery period. Dr. Whatley’s physical therapy team has these protocols, and they will be given to patients after surgery as well.
Most patients are able to achieve maximum range of motion and function in the new shoulder within about 3 months of surgery. While it is not always possible for patients with a shoulder replacement to achieve the full range of motion that an anatomical shoulder has, the result of surgery is typically a great improvement over previous shoulder function with arthritis and rotator cuff injuries.
Once fully recovered, patients are typically allowed to participate in sports like golf and tennis. Using lightweight dumbbells for exercise is also allowed, but heavy weightlifting is not. However, Dr. Whatley cautions patients to take extra care to protect the shoulder and prevent falls. If a shoulder fracture occurs after a shoulder replacement, a revision procedure is often needed. Due to the limited amount of bone in the shoulder, the results of a shoulder revision are typically not as satisfactory as with a hip or knee revision, so it is very important to protect the new shoulder.
Shoulder Replacement in Zachary, New Roads & St. Francisville, LA
Dr. Adam Whatley is a board certified orthopaedic surgeon with over 10 years of experience in practice. Shoulder replacement surgery was a large part of his fellowship training at Brigham and Women’s Hospital, as well. Dr. Whatley offers both standard total shoulder replacement and reverse total shoulder replacement for patients with rotator cuff injuries. If shoulder pain and range of motion issues are interfering with everyday life, Dr. Whatley is happy to provide a consultation and his expert opinion, but will not push a patient to have surgery if they are not ready.