Shoulder Replacement (Prosthesis)

Complete shoulder replacement, otherwise called all out shoulder arthroplasty, is the expulsion of parts of the shoulder joint, which are supplanted with counterfeit inserts to decrease torment and reestablish scope of turn and portability. It is exceptionally fruitful for treating the serious torment and firmness brought about by end-stage joint inflammation.

Shoulder joint inflammation is a condition wherein the smooth ligament that fronts of the bones of the shoulder deteriorate or break down. In a sound shoulder, these ligament surfaces grant the bones to serenely skim against each other. At the point when these ligament surfaces vanish, the bones come into direct contact, expanding erosion and making them roughen and harm one another. Bone-on bone development can be very excruciating and troublesome. Precisely embedded fake replacement surfaces reestablish torment free development, strength and capacity.

What Happens In Shoulder Replacement?

In customary shoulder replacement surgery, the harmed humeral head (the wad of the joint) is supplanted with a metal ball, and the glenoid pit (the joint attachment) is supplanted with a smooth plastic cup. (The humeral head is at the highest point of the humerus – the upper arm bone, and the glenoid is situated in the scapula – the shoulder edge.)

This metal-on-plastic embed framework (instead of metal-on-metal) is utilized in basically all shoulder replacement. In certain patients, for example, those with extreme shoulder cracks of the humeral head, an incomplete shoulder replacement (called hemi replacement) might be suggested. This method replaces the ball segment as it were.

Prosthetic Replacement Of The Shoulder Joint:

Shoulder replacement removes damaged areas of bone and replaces them with parts made of metal and plastic (implants). This surgery is called shoulder arthroplasty (ARTH-row-plas-tee).

The shoulder is a ball-and-socket joint. The round head (ball) of the upper arm bone fits into a shallow socket in the shoulder. Damage to the joint can cause pain, weakness and stiffness.

Shoulder implants are available in a few different shapes and a range of sizes. Replacement options include partial and total using either anatomic or reverse implants.

When is a shoulder prosthesis required?

Shoulder replacement surgery is required when the shoulder joint is destabilized to the extent that the arm can no longer be used without pain. This lack of pain free mobility in the joint, may be due to osteoarthritis, or following traumatic injury to the shoulder.

Implantation of a shoulder endoprosthesis is necessary if the wear or damage to the shoulder joint is so advanced, that non-operative and/or joint-preserving operations do not solve the problem.

This is often found in cases of advanced arthritis of the shoulder joint (osteoarthritis) where the wear on the articular cartilage surfaces (primary osteoarthritis) is particularly painful and movement has become extremely restrictive.

Furthermore, severe fractures or injuries to the upper arm humerus (glenoid fracture), changes in the blood flow to the humeral head (necrosis of the humeral head), rheumatic diseases (chronic polyarthritis), instability (chronic shoulder dislocation), or severe joint infection (omarthritis), lead to the damage and wear of the articular surfaces (Secondary osteoarthritis).

Causes

Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis is an age-related wear-and-tear type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.

Unfortunately, there is no way to prevent the development of osteoarthritis. It is a common reason people have shoulder replacement surgery.

Rheumatoid Arthritis

This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed inflammatory arthritis.

Post-traumatic Arthritis

This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments may damage the articular cartilage over time. This causes shoulder pain and limits shoulder function.

Rotator Cuff Tear Arthropathy

A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.

Avascular Necrosis (Osteonecrosis)

Avascular necrosis, or osteonecrosis, is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are all risk factors for avascular necrosis.

Severe Fractures

A severe fracture of the shoulder is another common reason people have shoulder replacements. When the head of the upper arm bone is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for severe shoulder fractures.

Failed Previous Shoulder Replacement Surgery

Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.

Shoulder replacement procedures

Depending on the type of joint damage you have, your doctor may recommend one of the following shoulder replacement options:

• Anatomic total shoulder replacement. Both the ball and the socket are replaced. The implants resemble the natural shape of the bones.
• Reverse total shoulder replacement. Both the ball and the socket are replaced, but the implants are reversed. The ball is attached to the shoulder blade and the socket is attached to the upper arm bone. This option typically is preferred if the rotator cuff is severely damaged.
• Partial shoulder replacement. Only the head (ball) of the joint is replaced. It may be recommended when only the ball side of the joint is damaged.

With intermediate degrees of residual weakness, pain or limitation of motion, rate by analogy to diagnostic codes 5200 and 5203.