From the Guidelines
Shoulder arthroplasty is recommended for patients with degenerative conditions, such as osteoarthrosis, who have not responded to conservative treatments, with total shoulder arthroplasty being the most common type and having superior clinical outcomes compared to hemiarthroplasty 1. When considering shoulder arthroplasty, it is essential to evaluate the type of procedure that would be most beneficial for the patient. The main types of shoulder arthroplasty include:
- Total shoulder arthroplasty, which replaces both the humeral head and glenoid
- Hemiarthroplasty, which replaces only the humeral head
- Reverse total shoulder arthroplasty, which reverses the normal ball-and-socket configuration and is typically used for patients with a deficient rotator cuff The choice of procedure depends on various factors, including the extent of the degenerative condition, the presence of rotator cuff tears, and the patient's overall health.
The complications associated with shoulder arthroplasty can be significant, with a reported complication rate of up to 39.8% and revision rates of up to 11% 1. Common complications include:
- Prosthetic loosening
- Glenohumeral instability
- Polyethylene wear
- Osteolysis
- Periprosthetic fracture
- Infection
- Nerve injury
- Deltoid dysfunction It is crucial to carefully evaluate the risks and benefits of shoulder arthroplasty and to discuss these with the patient before proceeding with the procedure.
Imaging plays a vital role in diagnosing postoperative complications of shoulder arthroplasties, and the imaging algorithm should always begin with an assessment of the hardware components, alignment, and surrounding osseous and soft-tissue structures 1. The selection of the next imaging modality depends on several factors, including findings on the initial imaging study, clinical suspicion of an osseous versus soft-tissue injury, or clinical suspicion of infection. The most recent evidence suggests that total shoulder arthroplasty is the preferred procedure for advanced shoulder osteoarthrosis due to its superior clinical outcomes 1.
From the Research
Overview of Shoulder Arthroplasty
- Shoulder arthroplasty (SA) has improved significantly over the last twenty years, offering effective treatment for patients with severe shoulder dysfunctions 2.
- The indications for SA have expanded, with common ones including glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus, and osteonecrosis of the humeral head 2, 3.
Types of Shoulder Arthroplasty
- There are various procedures, such as resurfacing of the humeral head, anatomic total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty 2.
- Each type of arthroplasty has its own indications, preoperative requirements, and postoperative appearance, as well as unique complications 3.
Outcomes and Complications
- The outcomes of SA are very satisfying in terms of pain relief and considerable improvements in shoulder function and motion 2.
- However, complications can occur, including periprosthetic fractures, infections, implant loosening, and instability, with a reasonable solution being conversion to reverse total shoulder arthroplasty 2.
- The survivorship of the prosthesis is up to 12 years, which is acceptable to patients, although long-term results are still not clear 2.
Comparison of Surgical Techniques
- Total shoulder arthroplasty seems to offer an advantage in terms of shoulder function compared to hemiarthroplasty, with no other clinical benefits 4.
- More studies are needed to compare clinical outcomes of surgery using different components and techniques in patients with osteoarthritis of the shoulder 4.
Rehabilitation and Treatment
- Rehabilitation following total shoulder arthroplasty is crucial, with the current Neer protocol being widely used and based on tradition and the basic science of soft tissue and bone healing 5.
- The primary indication for surgery is pain unresponsive to medical management, with hemiarthroplasty or total shoulder replacement being the procedure of choice for degenerative changes in the glenohumeral joint 6.