Shoulder replacement surgery can be performed for a number of reasons such as end-stage arthritis of the shoulder, large irreparable rotator cuff tears or even severe fractures around the shoulder. That said not all shoulder replacements are the same.
Types of Shoulder Replacement
In simple terms there are two distinct types of shoulder replacement: anatomic shoulder replacement and reverse shoulder replacement.
Anatomic Total Shoulder Replacement
In an anatomic shoulder replacement, the ball and socket of your shoulder are replaced with a metal or ceramic ball and a polyethylene socket that would match the normal anatomy of your shoulder. This type of shoulder replacement closely mimics normal shoulder mechanics and movement but relies on the normal function of soft tissues around the shoulder including your rotator cuff tendons.
If your primary problem is that the ball and socket of your shoulder are worn but the surrounding rotator cuff is in good condition, anatomic shoulder replacement is likely to be a very good option for you. These days there are a number of modern shoulder replacement implants designed specifically to address the unique characteristics of the shoulder joint.
Reverse Shoulder Replacement
While this may seem a little odd at first, in a reverse shoulder replacement, the ball and socket arrangement of your shoulder is switched around. That is, a metallic hemisphere is implanted on the socket side, and a corresponding socket and stem is implanted on what used to be the ball side of the joint.
What this does is significantly change the mechanics of the shoulder, shifting the centre of rotation of hand shoulder joint more towards the centre of your body. This allows the large deltoid muscle of the shoulder to maintain stability and provide range of motion of the shoulder joint in the absence of a functioning rotator cuff.
Given the prevalence of rotator cuff pathology, especially as we get older, this type of shoulder replacement has provided a reliable treatment option to patients who previously had to simply put up with a shoulder they couldn’t move. In Australia, reverse shoulder replacement has recently become the most common type of shoulder replacement performed with over 70% of shoulder replacements now being reverse.
Clearly this does not reproduce a ‘normal’ shoulder and it important to have realistic expectations of what to expect following reverse shoulder replacement. In general it would be fair to expect to restore a functional range of motion of your shoulder such that you could comfortably bring your hand to be back of your head and also bring your hand behind your body to your back pocket. Most day-to-day activities can be easily completed within this range of motion.
Undergoing shoulder replacement is a big decision but can restore significant function and relieve pain in your shoulder. You can expect a very honest assessment of what to expect and what options may be best suited to your individual circumstance. Following any shoulder replacement surgery, I will closely follow your progress to ensure that we achieve the best possible outcome for you.
Longevity of Shoulder Replacement
The longevity of reverse shoulder replacement is also a consideration, with reliable good results demonstrated for 10-15 years, but a possible reduction in function after this time – this means that this type of surgery may not be as suitable or may represent a degree of compromise in patients under the age of 65.
ABOUT DR JUSTIN ALEXANDER
Dr Justin Alexander is an Australian-trained orthopaedic surgeon specialising in treatment of the upper limb. After completing his orthopaedic surgical training in Adelaide, Justin spent a further 18 months working in highly specialised centres across Australia learning advanced techniques and acquiring vast experience in treatment of upper limb conditions.
Dr Alexander’s private practice is based in Adelaide at sportsmed’s Stepney Hub where he regularly consults and operates at sportsmed’s world class orthopaedic hospital. Justin also regularly consults in Mt Barker at Summit Health Centre and visits Broken Hill on a monthly basis.