Shoulder Replacement Surgery

Shoulder Arthritis

Arthritis is a degenerative condition in which the cartilage of the shoulder joint wears out over time. Healthy cartilage is a smooth surface, but as it begins to wear out, it can become a rough and bumpy surface, eventually getting to the point where the joint becomes “bone-on-bone”. On x-ray imaging, this shows up as narrowing of the space between the ball and socket as well as the formation of bone spurs (osteophytes). 

In patients with arthritis and a torn rotator cuff, x-rays may also show a high-riding humerus, indicating that the ball is no longer being properly held against the socket. This condition is known as rotator cuff arthropathy.

Arthritis can lead to several symptoms including pain, decreased range of motion, and mechanical symptoms such as popping, clicking, or a “crunchy” feeling within the joint.

The treatment of arthritis begins with non-invasive options, including anti-inflammatory medications, physical therapy, and/or steroid injections. These options may provide relief in early arthritis, but in the later stages they may prove to be ineffective. Ultimately, the “cure” for arthritis is a shoulder replacement.

Candidates for Shoulder Replacement

Our surgeons may recommend shoulder replacement if a patient is experiencing the following symptoms and has not had improvement with conservative treatments:

• Advanced arthritis in the shoulder causing shoulder pain that interferes with daily life
• Shoulder pain that continues while at rest, which may prevent the patient from sleeping at night
• Weakness and/or reduced range of motion in the shoulder

Sometimes, shoulder arthritis can occur along with other injuries, including rotator cuff tears and fractures. These patients may need a different surgical approach than patients who only have arthritis. Our surgeons evaluate all patients on an individual basis and will make recommendations based on the patient’s needs.

Shoulder Replacement Procedures

Dr. Cahill and Dr. Contreras are trained in different shoulder replacement procedures to meet the needs of our patients, including, traditional (anatomic) total shoulder replacement, reverse total shoulder replacement, and hemiarthroplasty.

Anatomic Total Shoulder Replacement

Anatomic shoulder replacement is used for patients with arthritis of the shoulder with an intact rotator cuff. This option most closely recreates the function and mobility of a normal shoulder. Total shoulder replacement involves removing the entire head of the humerus (upper arm) and replacing it with a stemmed metal ball-shaped implant. The socket is also replaced with an implant and lined with a plastic spacer.

Reverse Total Shoulder Replacement

A reverse shoulder replacement may be used in multiple scenarios, including arthritis with a torn rotator cuff, severe arthritis with deformity and an intact rotator cuff, large non-reparable rotator cuff tears, fractures of the proximal humerus, and more.

With this procedure, the positioning of the ball and socket are reversed. The head of the humerus is removed, but instead of replacing it with a ball implant, it is replaced with a stemmed socket implant. The damaged bone and cartilage is then removed from the natural shoulder socket, and a metal ball-shaped implant is put in its place. By reversing the positioning of the ball and socket, the shoulder can rely on the deltoid muscles to lift and rotate, rather than the rotator cuff.

Although the shoulder no longer has its “normal” orientation, a reverse shoulder replacement results in excellent pain relief and functions very well, allowing patients to reach overhead, perform everyday activities, and even return to playing sports like tennis and golf.

Pyrocarbon Hemiarthroplasty

A hemiarthroplasty (partial shoulder replacement) is a surgical treatment in which the ball of the shoulder is replaced with an artificial ball, but no artificial parts are used on the socket. Historically, a metal ball was used for this replacement, however more recently there has been a  transition to using a material called pyrocarbon. Pyrocarbon is a synthetic material that has properties that are more similar to your normal bone and cartilage, which theoretically decreases the risk for wearing out the socket, therefore increasing the lifespan of your implant when compared to metal surfaces. 

A pyrocarbon hemiarthroplasty may be indicated in multiple scenarios including very young patients with severe arthritis, avascular necrosis (loss of blood supply) of the humeral head, among others. Because there is no plastic component on the socket side, patients that undergo pyrocarbon hemiarthroplasty often have no restrictions after their recovery and may return to heavier lifting and other high demand activities.

Technology in Shoulder Replacement

Dr. Contreras obtains a CT scan prior to surgery for all shoulder replacements. This allows for precise planning of your surgery using 3D planning software and the ability to virtually implant the replacement parts into your bone, allowing for accurate matching of each component to your specific anatomy.

Dr. Contreras also uses the latest technology for his shoulder replacements including:

• Stemless anatomic humerus components – This type of humeral component (ball) results in less bone removal, leading to less pain and potentially faster recovery.
• Metal hybrid fixation of the anatomic glenoid (socket) component – This type of socket component allows bone to grow into the metal of the implant instead of solely relying on bone cement, resulting in a longer potential lifespan of your implant.
• Vitamin E polyethylene – This is the plastic component of your shoulder replacement. The addition of Vitamin E to highly crosslinked polyethylene improves the mechanical properties, potentially improving the longevity of your implant.
• Augmented glenoid (socket) components – Dr. Contreras is skilled in the use of augmented glenoid components which allow for correction of deformity that has resulted from arthritis.

Recovering from Shoulder Replacement

Dr. Cahill and Dr. Contreras perform shoulder replacements in both the hospital and surgical center settings. Many patients are able to go home the same day after surgery. Outpatient shoulder replacement has many benefits, including increased patient comfort and independence without increasing the risk of complications. Patients who aren’t candidates for same-day shoulder replacement generally only stay 1 night in the hospital.

As a part of a multi-modal pain control protocol, our surgeons use a nerve block for all shoulder replacements. A nerve block is a procedure in which the anesthesiologist injects numbing medication around the nerves that go to the shoulder and arm. This results in excellent pain control with minimal to no pain for the first 1-3 days after surgery. You are still asleep and under anesthesia for the entire surgery, but the nerve block allows for less anesthetic medication to be used, allowing for a quicker recovery after surgery.

In general, patients are in a sling between 2 and 4 weeks after a shoulder replacement and physical therapy lasts for a few months. Approximately 90% of the recovery occurs in the first 4-6 months, but many patients experience ongoing gains in function and endurance for an entire year after surgery.

Ultimately, each patient and shoulder is unique and warrants a thorough and informed discussion. Your surgeon will be with you every step of the way, providing guidance and an individualized treatment plan designed to help you achieve your goals and get you back to all of the activities that you would like to do.

Revision Shoulder Replacement

Unfortunately, shoulder replacements occasionally require revision surgery in order to fix one or more problems occurring with the artificial shoulder. Potential problems with a shoulder replacement include implants that were not implanted in an optimal position, failure of the rotator cuff in an anatomic shoulder replacement, loosening of one or more components, and infection. 

If you have a shoulder replacement that is painful or not allowing you to function at a level that you are happy with, please make an appointment with one of our surgeons for a consultation. We will perform a thorough investigation as to why your shoulder replacement may be causing your symptoms and come up with an individualized treatment plan to help get you back to where you want to be.

Shoulder Replacement in Bergen County, NJ

Cahill Orthopedic is located in Bergen County, NJ. Dr. James Cahill is a board-certified and fellowship trained orthopedic surgeon with several years of experience in joint replacement procedures, including shoulder replacement surgery. Dr. Erik Contreras is a fellowship trained shoulder and elbow surgeon. When shoulder replacement is needed, our surgeons use the latest techniques available. If you would like to schedule a consultation with Dr. Cahill or Dr. Contreras, please call our office at (201) 489-0022.