Shoulder joint replacement is a surgical procedure to replace damaged bone surfaces with artificial components to relieve pain and improve functional ability in the shoulder joint. Shoulder joint replacement can be done by a traditional "open" approach or through a minimally invasive approach. The incision in minimally invasive shoulder joint replacement is about 5 cm compared to 17 cm with the traditional approach. Other benefits of minimally invasive surgery include less damage to the soft tissues and underlying muscles enabling a faster recovery with less pain and a smaller scar. Blood loss during the surgery is also less and complications after the surgery are fewer when compared to the open technique.
Shoulder joint anatomy
The shoulder is a highly movable ball and socket joint allowing for various arm movements. The head of the arm bone or humerus, articulates with the glenoid socket of the shoulder bone or scapula. The two articulating surfaces of the bones are covered with cartilage which prevents friction between the moving bones. The rotator cuff is a group of four tendons that joins the head of the humerus to the deeper muscles and provides stability and mobility to the shoulder joint.
When conservative measures such as medications, injections, physical therapy and activity changes do not help relieve pain from conditions such as arthritis, avascular necrosis and humeral head fractures, then shoulder joint replacement is considered as a treatment option.
The goal of surgery is to relieve pain and improve mobility by replacing the damaged bone surfaces of the shoulder joint with artificial humeral and glenoid components.
The decision to perform shoulder replacement via the traditional approach or the minimally invasive approach depends on the pathology of the individual and the experience of the surgeon. Exposure of the glenoid is often difficult even when the incision is long as in the traditional approach. Therefore, if the pathology of the patient is such that more exposure of the joint is required for the surgical treatment then a traditional approach is preferred. The minimally invasive approach is generally preferred when the problem can be rectified by replacement of only the humeral head such as with the following conditions:
To check the pathology of the patient the surgeon orders an X-ray of the shoulder in the anteroposterior and axillary view. The axillary X-ray is especially important to check the condition of the glenoid. In case the condition is not very clear, the surgeon orders a CT scan of the shoulder to provide more detailed cross-sectional images of the bone and soft tissue of the shoulder including the glenoid.
The surgery is performed under sterile conditions in the operating room under regional or general anesthesia.
After the surgery, your arm will be placed in a sling which you will wear for 2-4 weeks while your shoulder heals. Pain medications and antibiotics are given to keep you comfortable and prevent infection.
The rehabilitation program includes physical therapy which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. Follow your therapist’s instructions for home exercises to achieve the best outcome.
It is critical to follow the postoperative instructions given to you by your surgical team.
The postoperative instructions include the following:
Risks and Complications
Some of the possible risks and complications of minimally invasive shoulder replacement include: infection, nerve injury and prosthesis problems. Most of these can be treated successfully; however, prosthesis problems such as excessive wear, loosening of components or dislocation may require additional revision surgery.
Minimally invasive shoulder replacement offers the same successful outcomes as traditional, larger-incision operations. It is performed through a smaller incision and causes minimal disruption to soft tissue structures allowing for a faster recovery with the additional benefit of a smaller scar.