Shoulder Replacements are good! And more common than you might think.

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By Harry Brownlow, November 2017

Most people have heard of hip and knee replacements but many are surprised to hear that shoulder replacements are also widely performed. Last year 6000 shoulder replacements were inserted in the UK. The commonest indication for a shoulder replacement is osteoarthritis of the shoulder joint. But other common reasons are arthritis associated with failure of the rotator cuff muscles (cuff tear arthropathy), the consequences of major shoulder trauma, and rheumatoid arthritis.

They come in 3 main varieties. A hemiarthroplasty describes a half shoulder replacement. That means the ball (humeral head) is replaced but the socket (glenoid) is left alone. This might be considered if the socket has been unaffected or when the patient is young but more normally the socket needs to be replaced too. When both the ball and socket are replaced it is described as a total shoulder replacement of which there are 2 varieties. The anatomic shoulder replacement describes replacing the ball with a metal ball and the socket with a plastic socket. This is the best option for typical osteoarthritis when the rotator cuff tendons are normally working well.

Shoulder Replacment

If the rotator cuff tendons are not working or are torn then an anatomic shoulder replacement cannot work and instead a reverse geometry total shoulder replacement is used. In this situation a metal ball is screwed into the old socket and a plastic lined socket is fitted onto a stem and is used to replace the humeral head.

Shoulder replacements are good for improving pain and movement and function. A recent study looking at the results of both anatomic and reverse total shoulder replacements from around the world showed that more than 95% of patients reported clinical improvement and that the majority of the improvement was achieved in the first 6 months but continued for up to 2 years from surgery (Simovitch et al, JBJS 2017). Other studies are watching the longterm results of shoulder replacements and the current evidence suggests that they are as good as total knee replacements.

Age itself should not preclude the need for a shoulder replacement. Indeed the highest revision rates are amongst young men and not older women!

So, shoulder replacement should not be forgotten as an important and even life changing option for someone who is struggling with constant pain and restricted function. Quality of life improvement comes quickly and the benefits should be long lasting.