Arthritis and Shoulder Joint Replacement

There are two main causes of arthritis of the shoulder: ‘Wear & Tear' osteoarthritis and rheumatoid arthritis. Rheumatoid arthritis affects many joints including the shoulder. The joint lining attacks the joint destroying the surface and the muscle tendons which control it. Patients often have so much pain from other joints that they neglect the shoulder until irreversible damage has occurred. Patients with rheumatoid arthritis of the shoulder should consult a shoulder surgeon early so that the joint can be monitored and surgery offered so that the patient may derive the maximum benefit from it. Osteoarthritis of the shoulder is actually quite uncommon. It is nothing like as common as arthritis of the knee or hip. It is probably a disorder with a strong genetic influence.

Treatment:

There are four different treatments for arthritis of the shoulder:
  1. Medications – analgesics and anti-inflammatory tablets
  2. Physiotherapy
  3. Cortisone Injections
  4. Joint Replacement surgery
Most patients will usually have exhausted medications by the time they seek specialist help. Physiotherapy is often useful and should be attempted before contemplating surgery. Cortisone injections can be of huge benefit in patients with arthritis. They can give rise to pain relief for many months. Unfortunately their effect wanes each time they are repeated. They do not damage the joint and they do not affect the patient generally. Surgery is only considered when everything else has failed to restore the patient's quality of life to a reasonable level. Though keyhole surgery is available, it seldom gives rise to sufficient benefit. Joint replacement surgery has been available for at least twenty years and modern techniques have a very high success and satisfaction rate. As with other joint replacements, the bearing is resurfaced with metal and plastic and this gives rise to terrific pain relief and restoration of function.

Surgery:

What the patient has to go through The patient is admitted on the day of surgery. The operation is usually performed under general anaesthetic with a nerve block, which prevents pain immediately after the surgery. It can be performed without a general anaesthetic. The surgery takes around ninety minutes. An incision is made down the front of the shoulder. The patient wakes with his arm in a sling and no feeling in it because of the nerve block. This lasts around twelve hours, then the sensation and movement returns. Pain killers are administered. The day after the surgery, the patient can get out of bed and walk around with the arm in the sling. Patients may go in the shower and may get the wound wet. They may get dressed in normal clothes but will still need the sling. The shoulder is acutely painful for two weeks and moderately painful for six weeks. Patients may discard the sling after three weeks, but most will wear it on and off for the full six weeks. Physiotherapy and exercises are commenced immediately after the surgery and continue for at least three months. Patients cannot drive for at least six and often eight weeks. Patients do not notice much benefit from the surgery for six weeks, but after three months the pain relief is usually dramatic. It takes at least four months for the stiffness to resolve. The shoulder continues to improve for a year.

Results:

This surgery has in excess of a 90% success rate in terms of pain relief. In patients with osteoarthritis, there will usually be an increased range of movement.

What can go wrong?

The biggest initial problem is infection. This is rare, less than 2%. If it occurs, it can be dealt with, but repeated surgery and a poor result may ensue . There are other rare problems including nerve damage, bone breakage and dislocation.

How long does the operation/joint replacement last?

In simple terms, around ten years. You need to discuss this with your surgeon.

Hemi-arthroplasty versus total shoulder replacement:

The shoulder has two parts, the ball and socket. It is possible to replace just the ball, or the ball and socket. You need to discuss this with your surgeon. Replacing the ball is a quicker easier operation, but the shoulder may hurt years later because the socket was not re-surfaced. Re-surfacing the socket then only helps in 50% of people. Replacing the socket is associated with more immediate complications. There is probably better pain relief in the first five years. The socket can then loosen and salvage surgery is difficult.