Shoulder – Treatment Options – Shoulder Replacement Surgery – Patient education information from Stryker

Shoulder replacement

When non-surgical and arthroscopic treatments do not bring enough relief and is impacting your everyday life, your doctor may advise a shoulder replacement, also called shoulder arthroplasty.

During a shoulder replacement surgery, your surgeon will replace the damaged end of the upper arm bone and shoulder socket (glenoid) with artificial implants. This allows your shoulder joint to move smoothly and relieves pain.

You have options even with shoulder replacement. Based on your joint condition, your surgeon may suggest a reverse shoulder replacement or total shoulder replacement to get you moving again. Today, with technological advancements surgeons have different tools to assist them in planning shoulder replacement based on each patient’s unique joint anatomy and condition. Like any surgery, joint replacement has risks. Speak to your doctor to determine if it is right for you.

Reverse shoulder replacement

A reverse shoulder replacement (reverse shoulder arthroplasty) is designed to treat shoulder joint problems that a standard total shoulder replacement cannot address. It may be recommended for patients who have completely torn or irreparable rotator cuff tendons, shoulder arthritis along with large RCT, severe shoulder fracture or shoulder dislocation with large RCT. This procedure reverses the shoulder anatomy i.e instead of recreating the ball and socket joint in which the top of the humerus serves as the ball that fits into the glenoid, the socket is created at the top of the humerus and ball is fitted into what had been the glenoid. A reverse shoulder replacement helps reduce pain and restore shoulder movement² allowing you to get back to activities you love.

3D pre-operative planning

Today, advances in technology allow surgeons to pre-plan reverse shoulder replacement with the help of 3D pre-operative planning software even before stepping inside the operating room. Using your CT scan, the software creates a 3D model of your shoulder. This enables your surgeon to plan your surgery in advance – determine the appropriate implant size and positioning per your unique shoulder anatomy^3,4,5,6. At times, the surgeon may order a 3D-printed guide, also called patient-specific instrumentation (PSI), that is custom-made for your shoulder. This guide assists your surgeon to replicate the plan precisely during your shoulder replacement surgery^3,4,5,6.

Benefits of 3D visualization

Better view of your unique shoulder anatomy and its wear patterns^3,4,5,6,7
More precise measurements^4,5,8
Your surgeon can determine better implant types and implant sizes based on your anatomy^7,8,9
Implant placement, to maximize bone preservation⁷

How 3D pre-operative planning works:

Step 1 - CT scan

Before surgery, a CT scan of your shoulder is taken. This enables your surgeon to visualize your unique shoulder anatomy.

Step 2 - Planning

Next, the CT scan images are loaded into the pre-operative planning software to develop a 3D model of your shoulder for your surgeon to virtually perform your shoulder replacement surgery.

Step 3 - Review and finalize

Based on your bone structure and joint damage, your surgeon will finalize a customized surgical plan, including implant size and placement, and may order a PSI to replicate the plan during surgery.

Step 4 - Surgery

During surgery, your surgeon will follow your customized surgical plan for your shoulder replacement.

Total shoulder replacement

In a primary total shoulder replacement, the original anatomy of the shoulder joint is maintained. This approach may be recommended for severe shoulder arthritis patients, whose rotator cuff is healthy and intact. Your surgeon will remove the diseased end of the upper arm bone (humeral head) and replace it with a spherical shaped implant that fits into a stem placed inside the bone. Then, the shoulder’s socket (glenoid) is prepared, and a plastic (polyethylene) cup is attached on it with bone cement.

Speak with your doctor to know the right treatment for your shoulder condition.

Learn more about your treatment options

References:

J Bone Joint Surg Am. Advance online publication. doi. 10.2106/JBJS.21.00667.
American Academy of Orthopaedic Surgeons. Treatment: Shoulder joint replacement. OrthoInfo. orthoinfo.org/en/treatment/shoulder-joint-replacement.
Joseph Iannotti, MD, PhD, Justin Baker, PhD, Eric Rodriguez, BS, John Brems, MD, Eric Ricchetti, MD, Mena Mesiha, MD, and Json Bryon, MS. Three-dimensional pre-operative planning and a novel information transfer technology improve glenoid component positioning.
Hoenecke HR jr1, Hermida JC, Flores-Hernandez C, D’Lima DD. Accuracy of CT based measurements of glenoid version for total shoulder arthroplasty.
Gilles Walch, MD, Peter S. Vereridis, MD, Pascal Boileau, MD, Pierric Derasart, M. Eng, Jean Chaoui, PhD. Three-dimensional planning and use of patient-specific guides improve glenoid component position: an in vitro study.
Hendel, et al. Comparison of Patient-Specific Instrumentation with Standard Surgical Instruments in Determining Glenoid Component Position. JBJS 2014; 96:e71(1-8)
Iannotti J, Jun, B.J, Patterson, Ricchetti E. Quantitative measurement of osseous pathology in advanced glenohumeral osteoarthritis. J Bone Elnow Surg. 2017;99:1460-8.
Boileau P, Cheval D, Gauci, MD, Holzer N, Chaoui J, Walch G. Automated three-dimensional of glenoid version and inclination in arthritic shoulders. J Bone Joint Surg. 2018 Jan 3; 100(1) 57-65.
Werner B, Hudek R, Burkhart K, Gohlke F. The influence of three-dimensional planning on decision-making in total shoulder arthroplasty. J Shoulder Elbow Arthroplasty. 2017 Feb 7; 28(8): 1477-1483.

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