Arthroplasty

Overview
Reviewed by Joseph Maloney, MD

(Also known as Joint Replacement or Total Shoulder Replacement)
Arthroplasty, from the words "arthro," or joint, and "plasty," or reshaping, means a complete replacement of all or part of the shoulder joint. Patients with severe Arthrosis, Rheumatoid Arthritis, or other degenerative shoulder conditions are the most likely candidates for shoulder arthroplasty.

As a result of a degenerative bone condition, defect, or necrosis, the head of the humerus, or upper-arm bone does not fit properly into the shoulder socket, or glenoid. To remedy this problem, a surgeon must open the shoulder joint, remove any damaged tissue within it, cut off a small portion of the humerus, and replace it with a prosthetic device. The damaged part of the glenoid is then removed and replaced with a prosthetic cap. This procedure is known as arthroplasty.

Detailed Description
Specialist
Orthopedic surgeon

Procedure
Before the Procedure:

The patient is dressed in a hospital gown and is anesthetized both by general anesthesia and nerve block, numbing the nerves to the shoulder and arm that come out of the neck. The area around the joint is cleansed to ensure sterility.

During the Procedure:

Arthroplasty can be compared to capping a tooth. The surgeon will remove dead or damaged tissue and replace it with a prosthetic that looks and functions like the original should have. To accomplish this, a surgeon makes a long incision to gain access into the shoulder joint. Dead tissue is debrided, or removed, and any damaged tissues are stitched or stapled together. Any rotator cuff damage is also repaired at this time. Next, the surgeon cuts off the damaged end of the humerus with a saw and drills holes in the healthy bone that will serve as anchor points. The surgeon then inserts the prosthesis cap into the end of the humerus. The cap is sealed with a thin coat of medical-grade cement, which works as a grout to seal the new cap and keep it stable. The shoulder is then stitched back together to complete the procedure.

Recovery:

A doctor will usually suggest that the patient wear a sling for comfort. A continuous passive motion machine may be used to prevent Adhesive Capsulitis (frozen shoulder) or shoulder stiffening. Often, the patient will remain in the hospital overnight at the doctor's request. Care must be taken to maintain a cleanly dressed wound while the surgical incision heals. Although the patient may feel an immediate reduction in pain, it is important to ease one's way back to activity, and only under the advice and supervision of a doctor or physical therapist.

Complications/Risks:

• Excessive bleeding
  
• Blood clots
  
• Nerve or blood vessel injury during surgery
  
• Infection
  
• Need for blood transfusion