The shoulder joint consists of a ball (humeral head), and a socket (glenoid).
In a normal joint the bones of both sides of the joint (the ball and socket), are covered with cartilage- a smooth substance that allows normal, painless motion. Osteoarthritis means loss of cartilage resulting in a “bone on bone” situation, and increased painful motion.
Pain will be in the shoulder and down the arm and is worse at night. There may be a “grating” feeling in the shoulder and most movements result in pain.
A doctor can diagnose it by a clinical examination and it can usually be confirmed on X-ray.
During the early phases anti-inflammatory medication can relieve the pain.
A cortisone injection into the joint can give significant relief in some patients.
An arthroscopic debridement (clean out of the joint) may help to relieve pain in some patients. This procedure is done with key-hole surgery. Although it is not a “guaranteed” procedure for pain relief, it is often successful enough to advise it to many of our patients.
The above procedures are usually done to “gain time”, and often the patient will eventually require a shoulder replacement to relieve the severe pain.
The painful bony surfaces are replaced with metal and plastic surfaces to provide painless motion. The ball (humeral head) is replaced with a metal head and the socket (glenoid) is resurfaced with a plastic insert. These materials are high quality Titanium and polyethylene.
Under general anaesthesia, an incision is made in front of the shoulder. The abnormal head is removed and a head is positioned in place. In my practice a hemi-arthroplasty is done. This means that I only replace the humerus head. Reverse Shoulder (Also known as total shoulder replacement) replacements are only done if the patient has a irreparable rotator cuff muscle as well.
The shoulder is kept pain-free with a nerve block for 1 to 2days. The patients arm is kept in a sling until the rotator cuff has healed- this takes 6 weeks. Physio therapy is started at this stage. The patient stays in the hospital for about 3 days until the activities can be done independently. A sling is worn for 6 weeks.
It may take a few months to reach the full benefit of the operation.
Most patients (80%) achieve good pain relief – increase in range of motion is usually a benefit, but is less predictable.
These are fortunately rare, but as with all joint replacements, may occur. These include infection, dislocation and in the long term components becoming loose.
These problems, although rare and unwanted, can usually be treated.