When nonsurgical treatment options have been exhausted, people who have moderate to severe shoulder arthritis might be advised to consider surgery. There are several types of surgeries performed to relieve shoulder osteoarthritis. Which type is recommended depends on the severity of the shoulder arthritis as well as other factors, such as age.
Shoulder replacements tend to have a shorter lifespan than knee and hip replacements. Younger patients with active lifestyles may be encouraged to consider less invasive surgical procedures before having a shoulder replacement surgery.
A surgeon can remove osteophytes (bone spurs) from the shoulder joint during a procedure called shoulder osteotomy. The goal is to reduce friction between the top of the humerus bone and glenoid (socket) during shoulder movement. Osteotomy is typically done with debridement.
During this surgical procedure, a surgeon will remove loose pieces of damaged cartilage and smooth out existing cartilage. Like osteotomy, the goal of debridement is to reduce friction in the shoulder joint.
Microfracture (Cartilage Regeneration)
If the osteoarthritic damage to cartilage is small and isolated, a doctor may recommend a cartilage regeneration procedure. Cartilage regeneration attempts to spur healing through the growth of new cartilage tissue. Cartilage does not contain blood vessels, and bleeding is necessary for healing. A surgeon can try to encourage new cartilage growth by making small cuts in the bone underneath the injured cartilage. The hope is that the blood from the damaged bone will facilitate new cartilage cell growth.
A surgeon may also apply platelet rich plasma or stem cells to area in an attempt to further encourage new cartilage cell growth. Microfracture may be done in combination with debridement and osteotomy.
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This surgery replaces only the humeral head, leaving the glenoid (socket) intact. Hemiarthroplasty may be recommended to:
- People who do not have osteoarthritis damage to the glenoid.
- Younger patients who do physical labor or who want to continue to participate in high-impact sports, such as tennis. (These activities can cause an artificial ball-and-socket joint to loosen and eventually fail.)
Hemiarthroplasty is somewhat controversial. While it preserves more bone tissue than a shoulder replacement, research shows it is generally less reliable in relieving shoulder pain.
For advanced shoulder arthritis, shoulder replacement is typically recommended. This surgery replaces the ball-and-socket glenohumeral joint with an artificial one. It involves cutting the arthritically damaged ends of the humerus and glenoid (shoulder socket) and capping both with prostheses (like capping teeth).
Shoulder replacement is a major surgery that requires a long recovery and rehabilitation process. Physical therapy is necessary to strengthen shoulder muscles and discourage scar tissue from forming. It may be 4 to 6 weeks before a person can resume driving.
Reverse Shoulder Replacement
Sometimes osteoarthritis leads to irreparable rotator cuff damage. A healthy rotator cuff is essential for a shoulder replacement to be successful. A person who has both shoulder osteoarthritis and a damaged rotator cuff may be advised to consider a reverse shoulder replacement.
A reverse shoulder replacement is similar to a traditional shoulder replacement, but the locations of the joint’s ball-and-socket are switched. A reverse shoulder replacement relies on the deltoid muscle, located at the top of the shoulder, to compensate for a weak rotator cuff.
People who have reverse replacements are typically advised to avoid strenuous movements, such as playing tennis or shoveling snow.
The majority of all shoulder surgeries are successful. However, complications can occur even when surgeries are done properly and go smoothly. A doctor and patient can talk about the existing wear-and-tear on the shoulder as well as the patient's lifestyle, hopes and expectations, and potential surgical risks.