What is Shoulder Arthroplasty?

Shoulder arthroplasty refers to the surgical replacement of the damaged articular surfaces of the shoulder joint with artificial implants, commonly known as prostheses.

There are several types of shoulder arthroplasty:

  • Hemiarthroplasty (replacement of the humeral head only)
  • Resurfacing hemiarthroplasty
  • Total shoulder arthroplasty (replacement of both the humeral head and the glenoid)
  • Reverse total shoulder arthroplasty

The specific type of procedure performed is determined by the orthopedic surgeon, depending on the underlying shoulder pathology and the integrity of the rotator cuff.

What are the Indications for Shoulder Arthroplasty?

Several conditions may necessitate shoulder arthroplasty. Common indications include:

Osteoarthritis (degenerative joint disease): In advanced stages, it causes significant pain and functional impairment.

Rheumatoid arthritis: A progressive autoimmune condition leading to joint destruction.

Post-traumatic arthritis: Resulting from previous fractures causing cartilage degeneration.

Rotator cuff arthropathy: Arthritis that develops due to long-standing rotator cuff tears.

Osteonecrosis (avascular necrosis): Leads to collapse of the humeral head and subsequent joint degeneration.

Comminuted fractures of the humeral head, especially in elderly patients.

Notably, many patients with arthritis may retain a functional shoulder. Thus, the decision to proceed with arthroplasty is made when:

  • Daily activities are significantly limited, affecting the patient’s quality of life.
  • Persistent, moderate-to-severe pain is present even at rest, often disturbing sleep.
  • Conservative treatments, including anti-inflammatory medications, intra-articular injections, and physiotherapy, have failed.

What is the preoperative evaluation for shoulder arthroscopy?

Prior to surgery, a thorough medical history is obtained and a cardiology evaluation is conducted. Additional imaging, such as a CT scan or MRI, may be recommended based on clinical need.

How is Shoulder Arthroplasty Performed?

The surgical procedure typically lasts about 1.5 hours. The orthopedic surgeon makes an incision of approximately 15 cm over the anterior aspect of the shoulder. The articular surfaces of the humeral head and glenoid cavity are removed to prepare the site for implant placement.

The humeral head is replaced with a metallic prosthesis made of cobalt-chrome or titanium alloys, which is either press-fit or cemented into place using a stem, designed to replicate the anatomy of the natural humeral head. The glenoid surface is replaced with a high-density polyethylene component that mimics the size, shape, and contour of the native glenoid.

Damaged articular surfaces are fully removed, and the prosthetic components are secured, with the use of bone cement if required.

What is the postoperative rehabilitation?

Patients usually remain hospitalized for approximately two days. Arm movement may begin immediately post-surgery, provided it is not painful. A specialized shoulder sling is typically recommended.
During the initial postoperative days, simple mobilization exercises are initiated. Subsequently, an intensive physiotherapy program begins under professional supervision, focusing on restoring range of motion and strengthening the shoulder.
Throughout the recovery period, regular follow-ups with the physician are essential to monitor progress.

Summary

Shoulder arthroplasty has become increasingly common in recent years due to its excellent clinical outcomes. Most patients report minimal discomfort postoperatively and significant improvements in shoulder mobility.
The performance and longevity of the prosthetic components depend on several factors, including the patient’s overall health, anatomical characteristics, body weight, activity level, and adherence to the physician’s pre- and postoperative instructions.