Total shoulder replacement gets patients back on track

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Total shoulder replacement gets patients back on track

The first shoulder replacement surgery was performed in the United States in the 1950s as a way to treat severe shoulder fractures. Since then shoulder joint replacement has proven beneficial for patients in the treatment of many painful conditions of the shoulder, including forms of arthritis. Today, about 53,000 people in the U.S. have shoulder replacement surgery each year. As we are living longer and the methods of total shoulder replacement surgery has evolved and improved, patients are seeking ways to live pain free from shoulder issues with total shoulder replacement, due to the substantial pain relief and long term functional benefits it can provide.

What causes shoulder weakness and pain

There are many issues that can lead to shoulder pain including osteoarthritis, rheumatoid arthritis, and injury from an accident or fall. In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. A total shoulder replacement involves replacing the arthritic or damaged joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket. In younger patients, repetitive movements required in various sporting activities can also cause early osteoarthritis, or wear and tear of the joint, resulting in the need for a replacement.

According to SRO shoulder expert Dr. Neema Pourtaheri there are actually two major types of shoulder replacement: standard and reverse. These terms can sometimes be a little confusing. “The major difference between a standard shoulder replacement and a reverse procedure is that in a reverse shoulder replacement (RTSR) the ball and socket parts of the shoulder joint switch locations,” explains Dr. Pourtaheri “With reverse total shoulder replacement, we essentially change the structure of the joint and the socket and metal ball are switched.”

In other words, with traditional total shoulder replacement, the ball and socket of the joint are simply replaced. The reverse total shoulder replacement procedure swaps the position of the ball and socket because of irreparable rotator cuff damage. “By reversing the ball and socket, we can mechanically repair the shoulder allowing for improved function and pain control,” Dr. Pourtaheri adds.

When a reverse prosthesis is better than standard shoulder replacement

With a standard total shoulder replacement procedure muscles and tendons around the shoulder joint are still healthy and can support a new joint. In this situation, muscles attach to the shoulder blade as they should, and are supported by tendons which connect to the shoulder. This configuration of muscles and tendons makes it possible to move the shoulder normally.

“In some patients, these tendons become damaged and torn to the point that they no longer support the bone structure of the shoulder, causing pain and significant loss of motion. Where a standard shoulder replacement procedure works great for patients where the supporting muscles and tendons of the rotator cuff are functional, a reverse total joint procedure is the better choice where it is torn or damaged,” explains Dr. Pourtaheri.

How rotator cuff becomes damaged

Due to the constant use and normally wide range of motion of the shoulder, the rotator cuff is susceptible to injury and tearing.  This type of wear and tear causes strain on the tendon which can develop painful tears over time, eventually resulting in chronic pain and disability. This type of slow deterioration can result in significant and irreversible degeneration.

Who qualifies for Reverse Total Shoulder surgery?

In most cases, rotator cuff degeneration makes it impossible for patients to qualify for traditional total shoulder replacement surgery and that is where reverse total shoulder replacement becomes a better option.

Reverse total shoulder replacement is often recommended for patients who have:

  • An irreparable torn rotator cuff
  • Cuff tear arthropathy
  • Experienced shoulder replacement previously that failed
  • Severe shoulder pain and difficulty lifting the arm normally
  • A complex fracture of the shoulder joint
  • A chronic shoulder dislocation
  • A tumor of the shoulder joint

Reverse total shoulder replacement is also recommended for patients who have repeatedly tried other treatments, such as rest, medications, cortisone injections, and physical therapy with little or no benefit.

Total shoulder replacement gets patients back on track

Research has shown that nearly all shoulder replacement patients under age 55 return to an active sports lifestyle, with more than 90 percent reporting in a 2017 study that they returned to a high-demand sport while 83.8 percent resumed a sport that required high use of the arms and shoulders. No matter what the age of the patient, most shoulder replacements last longer than 10 years as verified by researchers in a more recent study which found that patients can expect large and long-lasting improvements in pain, strength, range of movement, and their ability to complete everyday tasks.

“An important part of maintaining an active, healthy lifestyle is having flexibility and mobility in the shoulder,” explains Dr. Pourtaheri. “Nagging symptoms such as chronic pain and arthritis that limit mobility can challenge a person’s ability to participate fully in life. For these patients, either traditional shoulder replacement or reverse total shoulder replacement can make a huge difference in the level of enjoyment they can get out of life.” Orthopaedic surgeons like Dr. Pourtaheri offer a variety of non-surgical and surgical treatment options aimed at helping patients resume the activities that make life meaningful.

About Dr. Pourtaheri and SRO

Dr. Neema Pourtaheri is a board certified and fellowship trained orthopaedic surgeon who brings invaluable medical expertise to the SRO team. He has trained alongside some of the world’s finest orthopaedic surgeons and in highly versed in the latest advancements in shoulder and elbow care. In addition, he practices general orthopaedics including arthroscopy, fracture care, joint replacement, reverse total shoulder replacement and total shoulder & elbow replacement with a focus on minimally invasive procedures. Dr. Pourtaheri also performs Platelet Rich Plasma (PRP) injections to advance healing and pain relief when standard treatments are not as effective.

SRO offers patients in-house diagnostic imaging, rehabilitation, sports injury prevention, as well as advanced surgical treatments in joint replacement, sports medicine, trauma care, hand, foot and ankle, shoulder and elbow and general orthopedic surgery.

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