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© 2023 by Justin Chronister, MD 

What is total shoulder arthroplasty?

 

Orthopedic surgeons perform total shoulder arthroplasty (TSA) to treat severe shoulder pain and lack of motion. During TSA surgery, the surgeon replaces diseased and injured joint components with medical-grade implants designed to appear similar to our normal, healthy shoulder joint. The four important soft tissue stabilizers of the shoulder (often referred to as the rotator cuff) must be functioning well to support the TSA procedure.

With a total shoulder replacement, the surgeon replaces the top of the upper arm bone (humeral head) with a spherical shaped component that fits onto a stem placed inside the bone. The surgeon lines the shoulder’s natural socket (glenoid) with a special plastic (polyethylene) cup and secures it with bone cement.

In the operating room, once the incision is made, the surgeon will use a resection guide to determine the appropriate amount of affected (arthritic) bone to remove from the humerus. In order to prepare the humeral canal for the stem, the surgical team uses various tools to create a space for the stem. After preparing the canal, the surgeon prepares the glenoid socket for the plastic component. The glenoid component looks similar to a concave dish that may have multiple posts or a central keel on the back (convex) side of the implant. The surgeon then attaches the component to the shoulder socket with bone cement.

Common Causes of Shoulder Pain

Osteoarthritis (OA) is sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage and bones. With osteoarthritis, the cushioning cartilage at the end of the humerus may have worn down, making shoulder movement painful as bone rubs against bone.

Shoulder OA commonly occurs many years following a shoulder injury, such as a dislocation, that has led to joint instability and repeated shoulder dislocations ‐ damaging the shoulder to the point that OA develops.

Post-Traumatic arthritis may develop after an injury to the shoulder joint in which the bone and cartilage do not heal properly. The joint is no longer smooth and scar tissue develops. The scar tissue causes pain in the shoulder joint.1

Cuff tear arthropathy may develop after an significant injury to the rotator cuff muscle(s). In the presence of cuff tear arthropathy, multiple bony and soft tissues changes are present which may decrease the function and strength of your arm.

Rheumatoid Arthritis (RA) is an autoimmune disease in which the body's immune response negatively affects the lining of the joints (called the synovial membrane), causing chronic inflammation and pain. The synovium becomes thickened and inflamed. In turn, too much synovial fluid is produced within the joint space, which causes a chronic inflammation that damages the cartilage, and wears out the ball and socket. This results in cartilage loss, pain, and stiffness.

Avascular Necrosis (AVN) results when bone is deprived of its normal blood supply. Without proper nutrition from the blood, the bone's structure weakens, may collapse and damage the cartilage. Since this is most often seen at the ends of bones, your joints may be greatly affected. This is especially true of the shoulder joint and most commonly appears at the top end of the upper arm bone, the long bone that extends from the elbow to the shoulder.

Treatment Options for Shoulder Pain

Take the first step towards returning to the everyday activities you enjoy by scheduling an appointment with a surgeon today. Your orthopedic surgeon will review and discuss their diagnosis with you. Based on his/her diagnosis, your treatment options may include: 

Shoulder implants are designed to enable the joint to move more similar to that of a healthy, functioning joint When speaking with your surgeon about shoulder replacement surgery, it is important to understand the different surgical techniques and options available to you in addressing your joint pain. 

When learning about surgical treatment options, a few common terms to know are TSA, Total Shoulder Arthroplasty, and RSA, Reverse shoulder arthroplasty. Arthroplasty is a medical term used to describe a procedure in which the effected joint is reconstructed or replaced which may allow it to move more naturally after the procedure.

Both, a TSA and RSA are intended to relieve pain and restore some function in the shoulder. The surgical approach, or incision for a TSA and RSA are very similar and involve the restoration of the ball (humeral head) and socket (glenoid implant). There are other surgical options such a hemi arthroplasty (or partial shoulder replacement) where only the humeral head is replaced due to various reasons, an example being avascular necrosis.7

References:
  1. The Arthritis Foundation. What is Osteoarthritis. https://www.arthritis.org/about-arthritis/types/osteoarthritis/.

  2. Rotator cuff tear arthropathy: evaluation, diagnosis, and treatment: AAOS exhibit selection. Bone Joint Surg Am. 2012 Mar 21;94(6):e34. dos: 10.2106/JBJS.K.00746. Nam D, Maak TG, Raphael BS, Kepler CK, Cross MB, Warren RF. https://www.ncbi.nlm.nih.gov/pubmed/22438007.

  3. The Mayo Clinic. Dislocated Shoulder. https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859.

  4. The Center for Disease Control and Prevention. Arthritis. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/arthritis.htm