Anatomical Total Shoulder Replacement (Arthroplasty)
Restoring Movement & Relieving Pain in the shoulder
Anatomical shoulder replacement, also known as shoulder arthroplasty, is a surgical procedure that replaces the damaged or arthritic parts of the shoulder joint to restore smooth movement and relieve pain. The procedure involves replacing the humeral head (the ball at the top of the arm bone) with a prosthetic ball made of metal, plastic, or ceramic. The glenoid socket is fitted with a plastic liner, allowing for natural joint motion.
This type of shoulder replacement is best suited for patients with severe arthritis or joint damage but with intact and functional rotator cuff muscles. The rotator cuff plays a key role in stabilising the shoulder and ensuring the replacement moves properly, allowing patients to regain strength, mobility, and improved function.
CONDITIONS THAT MAY REQUIRE A SHOULDER REPLACEMENT
Anatomical shoulder replacement is typically recommended for individuals suffering from:
- Osteoarthritis: Degeneration of the shoulder joint cartilage can lead to pain, stiffness, and limited movement.
- Rheumatoid Arthritis: Inflammatory arthritis can damage the shoulder joint, causing pain and swelling.
- Severe Fractures: Complex fractures of the shoulder may require joint replacement if the bone cannot be repaired.
- Avascular Necrosis: Lack of blood supply to the humeral head can lead to bone death and joint collapse, making replacement necessary.
To determine if anatomical total shoulder replacement is appropriate, Dr Liddell will begin with a detailed examination and review of your symptoms.
This will include assessing your shoulder’s range of motion and testing its strength.
Imaging tests are key to diagnosing the severity of joint damage:
- X-rays: This helps assess the degree of cartilage loss, joint space narrowing, and bone damage.
- MRI or CT scan: These advanced imaging tests may be used to get a better look at the bones, cartilage, and surrounding soft tissues, such as the rotator cuff, ensuring the most appropriate treatment plan.
Patients who have an intact rotator cuff and are experiencing debilitating pain or functional limitations that have not improved with non-surgical treatments are the best candidates for this procedure.
THE ANATOMICAL SHOULDER REPLACEMENT SURGICAL PROCEDURE
Anatomical total shoulder replacement is performed under sterile surgical conditions to restore joint function and relieve pain. The procedure involves carefully removing damaged joint surfaces and replacing them with prosthetic components designed to replicate the natural anatomy of the shoulder. Each step is meticulously planned to optimise movement, stability, and long-term outcomes..
Anatomical shoulder replacement is typically performed under either general anaesthesia or regional anaesthesia (a nerve block), depending on your specific case and preferences. General anaesthesia means you will be asleep during the procedure, while a nerve block numbs the shoulder and arm area, often used with sedation to keep you comfortable. Dr Liddell and the anaesthesia team will discuss the best option for you based on your overall health and comfort.
Once anaesthesia is administered, the surgical team will position your shoulder to allow for optimal access to the joint. A sterilised area will be prepared, and the procedure will begin.
The first step involves accessing the shoulder joint through a carefully placed incision, usually on the front or side of the shoulder. Dr Liddell will carefully remove any damaged or worn parts of the shoulder joint, which typically includes the humeral head (the ball of the upper arm bone) and, if necessary, the glenoid (the socket of the shoulder blade). This process may involve removing bone spurs or areas where the cartilage has worn away due to arthritis, as these contribute to pain and limited movement.
Once the damaged humeral head is removed, it is replaced with a metal or ceramic prosthetic ball. This prosthesis is shaped to replicate the natural ball of the upper arm bone and is attached securely to the bone. In most cases, the upper portion of the humerus (the long bone of the arm) is prepared to fit a stem that is inserted inside the bone. This stem holds the prosthetic ball in place and ensures stability and durability for the joint. The material used (metal or ceramic) is chosen based on its strength and long-term compatibility with the body.
The next step involves addressing the glenoid socket. The glenoid is the shallow socket of the shoulder blade where the humeral head fits. A plastic liner is carefully placed into the glenoid after removing any damaged cartilage or bone. This liner is attached using a special type of medical-grade cement or secured with screws, depending on the condition of the bone. The liner provides a smooth, durable surface that interacts with the new humeral head, allowing for fluid movement and reduced friction within the joint.
A key part of the success of an anatomical total shoulder replacement is the integrity of the rotator cuff muscles. These muscles and tendons surround the shoulder joint and are responsible for stabilising and controlling the movement of the shoulder. During the procedure, Dr Liddell will ensure that these muscles are preserved and protected, as they play a critical role in keeping the new ball securely in the socket after the replacement. If the rotator cuff is intact and functioning before surgery, it will continue to provide stability for the new joint, allowing for smoother movement and reduced wear on the prosthetic components.
Once the prosthetic components are securely in place and the joint is checked for proper alignment and stability, Dr Liddell will close the incision with sutures or staples. A sterile dressing will be applied to protect the wound.
Immediately after the procedure, you will be fitted with a sling or shoulder immobiliser to keep the arm in place and allow the new joint to begin healing. Dr Liddell and his team will monitor you in the recovery room to ensure that you are comfortable and recovering well from the anaesthesia. You will also receive instructions on post-operative care, including pain management and when to begin the initial steps of rehabilitation.
RECOVERY AND REHABILITATION FOLLOWING ANATOMICAL TOTAL SHOULDER REPLACEMENT
Recovering from an anatomical total shoulder replacement is a gradual process that requires dedication to post-operative care and rehabilitation to ensure the best possible outcome. Your recovery will depend on several factors, including your overall health, adherence to your rehabilitation plan, and the condition of your shoulder before surgery. While recovery timelines can vary from person to person, the following provides a general guide on what to expect in the weeks and months following surgery.
IMMEDIATE POST-OPERATIVE PERIOD: FIRST 1-2 WEEKS
- Hospital Stay: After your surgery, you may stay in the hospital for one to two nights, depending on how well you recover from the procedure. During this time, your medical team will monitor your pain, help manage any discomfort, and ensure the shoulder is properly protected in a sling. Some patients may be discharged the same day, but this will depend on the complexity of the surgery and your specific case.
- Immobilisation and Sling Use: For the first few weeks after surgery, you will need to wear a sling or shoulder immobiliser to protect your shoulder and allow the new joint to heal. The sling keeps your arm close to your body and prevents accidental movements that could disrupt the healing process. It is important to wear the sling at all times, even when sleeping, unless instructed otherwise by Dr Liddell or your physiotherapist.
- Pain Management: Post-operative pain is common, but it typically improves within the first few days. Pain is managed through a combination of prescribed medications, such as anti-inflammatory drugs and pain relievers. Using ice packs and elevating your arm as directed can also help reduce swelling and discomfort.
EARLY REHABILITATION: 2-6 WEEKS
- Gentle Passive Movements: Within the first two weeks, your physiotherapist will guide you through passive range-of-motion exercises. These exercises involve gentle movements where the physiotherapist moves your arm for you, helping to maintain mobility in the shoulder joint without engaging your muscles. These movements are crucial for preventing stiffness but should only be done under the guidance of a physiotherapist to avoid stressing the joint prematurely.
- Restrictions: It’s important to avoid active use of the shoulder during this period. Lifting, pushing, pulling, and reaching overhead should be avoided to protect the healing tissues. Follow the specific restrictions provided by your surgeon and physiotherapist to ensure the best outcome.
INTERMEDIATE REHABILITATION: 6-12 WEEKS
- Transition to Active Motion: By 6 weeks post-surgery, most patients begin active range-of-motion exercises. This phase of rehabilitation allows you to start moving the shoulder on your own, but still within a controlled and guided program. The goal is to restore mobility and gradually improve shoulder function without compromising the healing process.
- Weaning off the Sling: Around 6-8 weeks after surgery, you may begin to wean off the sling as instructed by your physiotherapist. You will be able to use your arm for light daily activities, such as dressing or eating, but avoid heavy lifting or strenuous tasks.
- Strengthening Exercises: At this stage, you will begin strengthening exercises designed to rebuild the muscles around the shoulder, particularly the rotator cuff and scapular stabilisers. These exercises are performed gently and gradually, focusing on regaining muscle strength and endurance while protecting the joint.
LATE REHABILITATION: 3-6 MONTHS
- Regaining Full Range of Motion: By 3 months post-surgery, most patients experience significant improvements in range of motion and strength. Your physiotherapist will guide you through more challenging exercises aimed at improving flexibility, stability, and overall shoulder function. However, heavy lifting and high-impact activities should still be avoided.
- Return to Daily Activities: At around 4-6 months post-surgery, many patients are able to return to light to moderate activities, including household tasks, driving, and low-impact exercises such as walking or stationary cycling. Your shoulder will continue to gain strength, and you may notice a significant reduction in pain compared to pre-surgery levels.
FULL RECOVERY: 6-12 MONTHS
- Return to Sports and Hobbies: By 6-9 months after surgery, most patients are able to resume activities like swimming, golf, or gardening. However, high-impact sports and activities involving heavy lifting may need to be postponed until 9-12 months, depending on your progress and the guidance of Dr Liddell.
- Ongoing Strength and Mobility Improvements: Full recovery can take up to 12 months, during which time you may continue to experience gradual improvements in strength, mobility, and endurance. Regular physiotherapy and home exercises remain important to optimise shoulder function and maintain flexibility. Although the range of motion may not be fully restored to pre-arthritis levels, most patients report significant pain relief and an enhanced ability to perform daily activities.
LONG-TERM OUTLOOK
Anatomical shoulder replacement has a high success rate, with the majority of patients experiencing lasting pain relief and improved shoulder function. It is important to follow up with Dr Liddell for regular check-ups to ensure that the joint is functioning well and to address any concerns. While shoulder replacements are designed to be durable, avoiding excessive strain on the joint can help extend the lifespan of the prosthetic components.
POTENTIAL RISKS AND OUTCOMES FOR ANATOMICAL TOTAL SHOULDER REPLACEMENT SURGERY
As with any surgical procedure, there are risks associated with shoulder replacement surgery, including infection, blood clots, or complications with the prosthetic components. Shoulder replacements do however have a high success rate when performed by experienced surgeons like Dr Liddell.
The primary goal of anatomical shoulder replacement is to significantly reduce pain and improve function. While some limitations in range of motion may persist, most patients experience a substantial improvement in their quality of life and the ability to perform daily activities pain-free.