Shoulder & Elbow Replacement

Total Shoulder Replacement

Total Shoulder Replacement is one of the many successful procedures performed by Sunshine’s Orthopedic Surgeons for treatment of severe discomfort and stiffness in the shoulder joint. This usually occurs at the end stage of arthritis or a degenerative joint disease. Total Shoulder Arthroplasty (TSA) benefits patients by providing pain relief, restores functions, movement and strength of the joint.

Diagnosis

Shoulder discomfort that cannot be checked by anti-inflammatory medications and non-operative treatments, should then be considered for TSA. Grinding/grating sensation, increasing pain and stiffness within the shoulder joint usually require to be checked for a TSA.  A CT scan, X-rays, MRI tests, at times an EMG test may be performed to evaluate the extent of damage of the joint. In chronic cases of Ankylosing Spondylitis, TSA is considered regardless of the pain experienced by the patient.

Patient suffering from early osteoarthritis may consider alternative methods of physio therapy, medication, cortisone injections, shoulder arthroscopy, steroid injections and so on. In case there is not enough relief from the above procedures; TSA is the only further option.

Procedure and Implant

For shoulder conditions involving a tear or diseased rotator cuff or a labral tear, a minimally invasive shoulder arthroscopy is recommended. A TSA, however, is more complicated and requires open surgery. Either regional anesthesia or general anesthesia is used for this surgery. The patient is seated in a ‘beach-chair’ position during the surgery.

The surgery involves replacing the humeral head (or joint ball) and the glenoid (the socket). The goal is to remove the humeral head, replace it with a metal ‘ball’ that extends the stem down into the patients upper arm bone, and then place a plastic socket over the surface of the existing glenoid.

Pre and post operative care

The patient usually wakes up with an immobilized arm and pain due to surgery. However, such discomfort is different from the earlier arthritic pain experienced. Easy shoulder mobility is encouraged and light activity can be resumed approximately four weeks post surgery. Unrestricted active use of the arm and shoulder can begin 8 weeks after surgery. A year after the surgery, approximately 95% of the patients will not have any significant strength limitations.

Risks

Rare complications include shoulder stiffness, instability, infection, nerve damage and glenoid loosening. However, it is important to understand that proper and extensive post-operative care is necessary for gaining maximum benefits from the TSA.

Elbow Replacement

The loss of use of the elbow can be incapacitating and prevents the performance of basic daily chores. Total elbow replacement is the corrective surgery for such a loss. Unlike the success of knee and hip replacement surgeries, an elbow replacement does not enjoy a significant recognizable success. The history of elbow replacement is tarnished by bad implants that loosened within a few years, and required revision procedures often. However, today, elbow replacement has come a long way. These implants now enjoy a success rate of atleast 10 years in 90% of the patients.

Our elbow is a complicated hinge joint allowing a range of movements. Hence, an implant for an elbow becomes difficult as it has to perform and mimic all the functions of an elbow. Besides this, a flange (type of rod) has to be inserted in the ulna (a bone in the lower arm) that is prone to dissolving or osteolysis. The wear and tear of the implant causes it to break and grind into small articles, at times, 200 times smaller than a grain of sand. Also the constant frequent use of this implanted joint causes it to loosen. Implant loosening is one of the major issues faced in elbow replacement. Such a loosening is both a mechanical and a biological problem.

However, with advanced surgical techniques, and improved implant design and coating at Sunshine Hospitals, the orthopedic surgeons offer increased longevity for elbow replacements. Custom made implants are adopted by the surgeons, increasing the survival and success rates of these surgeries.