Those whose golf or tennis games are on hold due to chronic shoulder pain and stiffness might find themselves considering joint replacement surgery.
First performed in the 1950s, the surgery was invented to treat serious breaks in the ball or socket of the shoulder joint that could not be reset using traditional methods. Today, the procedure is less common than knee or hip replacement, though 53,000 people receive it each year.
Beyond serious injuries, the most common reason the shoulder joint fails is advanced arthritis, a common inflammatory condition that causes the joint to deteriorate. Symptoms can be managed with an anti-inflammatory drug or disease-modifying anti-rheumatic drug, but this doesn’t completely stop deterioration.
“If you’ve tried medication and physical therapy but are not seeing results, your doctor may recommend shoulder replacement surgery,” said Dr. Hithem Rahmi, a Geisinger fellowship-trained orthopedic surgeon. “It’s a consistently successful procedure that minimizes pain and can get you back to a normal life.”
When a patient gets a total shoulder replacement, the orthopedic surgeon will replace the failing joint with a metal ball and stem inside of a plastic socket. If the tendons in the rotator cuff are intact, the patient will have the standard replacement, in which joint placement mimics biological joints. However, some people with tissue damage may have a reverse total shoulder replacement, where the socket is attached to the bone and the ball to the shoulder bone.
“The reverse total joint replacement accesses a different muscle group and can restore full range of motion in patients with existing damage,” said Rahmi.
If patients are dealing with pain, but the joint’s socket is fully intact, the ball of the joint may be the source of the problem. In this case, the surgeon will recommend a procedure called a stemmed hemiarthroplasty, where just the ball at the end of the joint is replaced with a long-stemmed prosthetic.
Finally, there’s a resurfacing hemiarthroplasty, which is similar to a stemmed hemiarthroplasty because the socket is fully intact. But in this case, the ball is salvageable. Instead of replacing the ball, the surgeon places a cap on the existing joint. This method is best for younger patients who want to avoid the wear and tear of a full replacement.
Most patients are discharged from the hospital two or three days after the surgery. Soon after surgery, while still in the hospital, a care team will begin teaching the patient subtle rehabilitation exercises to strengthen the joint and improve flexibility.
The patient then will have to wear a sling for up to four weeks while the joint heals and take part in physical therapy to continue building strength and dexterity.
“Recovery after joint replacement surgery is a long road,” said Rahmi. “It’s important to follow your doctor’s orders with for physical therapy and limiting movement.”
With work, patients can restore strength and movement in the joint within a year, returning to the golf course or tennis court pain-free.