Last year more than 55,000 total shoulder replacement surgeries were performed in the United States. The majority of those having the operation were suffering from debilitating arthritis, and the results were a loss of pain and the gaining of mobility they had not enjoyed for some time.
Dr. Ian Byram of Bone and Joint Institute of Tennessee is a shoulder and elbow specialist who serves on the board of the American Shoulder and Elbow Surgeons (ASES) Foundation and as a member of the Association of Clinical Elbow and Shoulder Surgeons (ACESS). He participates on committees involved in research into new technologies and procedures to make total shoulder replacement consistently more successful through research based strategies. Dr. Byram recently took some time to discuss total shoulder replacement surgery with us.
Williamson Source: Let’s start with the basics, what is total shoulder replacement surgery?
Dr. Byram: Total shoulder replacement means that you remove the regular worn out surface of the ball and socket and replace it with metal and plastic. Arthritis wears away the cartilage and in some cases the bone, causing pain and loss of mobility. The replacement allows the ball and socket to glide freely again.
WS: Aren’t there two forms of total shoulder replacement?
Dr. Byram: Yes. The traditional “anatomic” form, and reverse replacement. In reverse replacement, we place the ball on the socket and the cup on the humerus, where the ball used to be. This surgery is performed when there is damage to the rotator cuff or significant bone loss. Basically, we are turning the shoulder into a more constrained joint like a hip. This provides more stability and allows the patient to raise their arm even when they have no rotator cuff. It is a solution for fractures, bone loss and rotator cuff deficiency – problems that we did not have great surgical options for in the past. Reverse total shoulder replacement has revolutionized the surgery with excellent results.
WS: When do you recommend total shoulder replacement surgery to your patients?
Dr. Byram: When they are unsatisfied with their pain and function and every other option has been employed. And I do not tell them, they tell me. Regular “anatomic” total shoulder replacement surgery will provide near total range of motion recovery, while reverse replacement will provide 10% to 20% less than at the patient’s peak shoulder health, but considerably more than without the surgery.
WS: How long does it take to recover from the operation?
Dr. Byram: In many instances, total shoulder replacement surgery can now be done on an outpatient basis. When performed as an inpatient, the vast majority of patients go home the day after the surgery with a sling and a pillow to immobilize the arm. Patients will remain in the sling for six weeks, except when showering or doing physical therapy.
A physical therapist will see the patient the same day or the next day after the surgery, giving them exercises to start at home. After that, physical therapy is performed twice a week for approximately 12 weeks. Return to regular activities of daily living will take place in about two months, and more vigorous activities like golf in about four to six months.
WS: You talked about reverse total shoulder surgery solving certain problems that had not been solved in the past, how long have these procedures been around?
Dr. Byram: Many of the techniques and technology we use today were not around 20 years ago, so we are still collecting data. But what we have so far looks good. Much like hip and knee replacement, we believe that the procedure and the implants will last approximately 20 to 25 years. Answering these types of questions is the sort of thing that gets me excited about research and implant design.
WS: Tell us about some of the new technologies you are using?
Dr. Byram: I am on a team that is working on computer assisted navigation in total shoulder replacement surgery. The surgeon uses CT scans to plan the surgery, and then uses a computer tied into the patient’s unique CT scan to see exactly where he or she is operating and the computer ensures that the plan is followed accurately. It means the surgery is more precise than traditional “free hand” surgery. It is a concept borrowed from skull based surgery.
Unfortunately one technology that is still not yet a great solution for end stage arthritis is stem cell treatments to regenerate cartilage. It would be great if we can get there one day, but currently there is little data to suggest that stem cells can fully regenerate cartilage once it is completely worn away. Steroid shots and physical therapy can help to some extent, but if the pain and loss of movement become too severe, surgery becomes the most reliable treatment option.
WS: What can someone do now to head off total shoulder replacement surgery?
Dr. Byram: Do exercises that focus on the movement of the shoulder and rotator cuff. Keep the muscles of your shoulder strong and flexible.
If you are suffering from shoulder pain, contact Bone and Joint Institute of Tennessee