Minimally Invasive Rotator Cuff Sparing Shoulder Replacement Surgery

Glenohumeral (shoulder) arthritis occurs when the protective cartilage on the surface of the glenoid (socket of the shoulder joint) and the humeral head (ball of the shoulder joint of the upper arm) wears out. As a result, patients experience shoulder pain, decreased range of motion, decreased strength, and functional limitation as the worn ends of the bones grind together, deform, and cause inflammation.

This cartilage surface breaks down from genetic susceptibility, excessive joint loading over time, systemic disease, or following injury.  Previous injury to the glenohumeral joint can damage the cartilage and result in accelerated wearing out of the protective cartilage on the ends of the bones, i.e. arthritis. Heavy and/or repetitive loading of the shoulder joint over prolonged periods of time such as those associated with weightlifting and/or heavy labor can accelerate the arthritis process. Some patients are genetically more susceptible to developing arthritis. Patients with susceptibility may develop arthritis regardless of activity level. Additionally, inflammatory or autoimmune diseases that damage articular cartilage, such as rheumatoid arthritis can cause arthritis.

• Shoulder pain, weakness, and decreased range of motion
• Shoulder pain that worsens with activity
• Shoulder stiffness that is worse in the morning or with a lack of activity
• Pain at night that affects the patient’s ability to sleep due to increased activity during the day

Shoulder (glenohumeral joint) arthritis is diagnosed through a combination of patient history, physical exam and x-ray imaging. Commonly, patients will report a history of previous shoulder injury or surgery, family history of arthritis, or history of autoimmune disease other systemic health issues affecting their joints. Physical exam typically reveals reduced range of motion, pain with motion, and strength deficits. X-ray imaging will often reveal the presence of shoulder (glenohumeral) joint arthritis and the degree of severity as well.  Sometimes MRI is also helpful for directly visualizing damaged cartilage.

The treatment and outcomes depend upon age, symptoms, severity, deformity, and other associated shoulder pathology like rotator cuff tears. Not all patients with X-ray findings of shoulder (glenohumeral) joint arthritis have pain. Typically, it is the younger, more active patients (who place higher demands on their shoulders) that have more pain. Older, less demanding patients can often expect excellent results by utilizing conservative management.

Initial treatment consists of activity modification (reduce the aggravating activities) as well as rest, ice, and anti-inflammatory medications to relieve pain. Specific physical therapy programs and injections can reduce inflammation and pain and improve motion and function. Shoulder replacement surgery is beneficial when patients continue to have symptoms despite conservative treatment. In rare cases, extreme loss of shoulder motion and erosion (destruction) of the glenoid (socket of the shoulder joint) call for earlier intervention and surgery.

When symptoms warrant, Dr. Chudik can replace the damaged and arthritic joint surfaces of the shoulder. In general, shoulder replacement (total shoulder arthroplasty) surgery is well-tolerated. Shoulders with a compromised or chronically torn and irreparable rotator cuff, severe deformity, or instability may require a reverse shoulder replacement.

• As long as the patient is otherwise healthy, shoulder replacement surgery is performed at an outpatient facility and the patient can safely return home the same day as surgery.
• The surgery is performed under limited general anesthesia and an interscalene nerve block (local anesthetics are used to numb the entire shoulder and arm for up to 12-24 hours after surgery).
• During traditional techniques of shoulder replacement surgery, the rotator cuff needs to be cut for proper exposure and then repaired which requires the patient to wear a sling and not use arm for 6 weeks following surgery.
• The patient is not allowed to actively move their shoulder with their own shoulder muscles for at least six weeks following surgery in order to protect the rotator cuff and allow it to heal.
• It may feel more comfortable sleeping sitting upright on a couch, recliner chair, or propped up in bed after surgery.
• It is important to keep the wound clean and dry for 10 to 14 days following open shoulder surgery. Showering lightly after 14 days is fine but wounds cannot be submerged under water until three weeks after surgery.
• Driving is typically acceptable at 6 to 8 weeks after surgery. Physical therapy should begin two to three days after surgery and continue for four months. The success of a shoulder replacement surgery is highly dependent on the post-operative rehabilitation. It is crucial to follow through and maintain a proper therapy schedule.

• The patient may return to sedentary work in less than one to two weeks as long as they are in their sling and do not use the involved extremity.
• No typing, writing, or purposeful movement of that arm is allowed for the first six weeks following surgery.
• The patient may return to their previous recreational activities when their rehabilitation is complete and functional use has been restored.
• Usually, four to six months is necessary to restore range of motion and strength and allow a safe return to activities. Dr. Chudik has specialized programs for returning to activities such as golf that will be discussed at the patient follow-up appointments.

The goal of shoulder replacement surgery is to relieve the patient’s pain from shoulder (glenohumeral) joint arthritis. Returning to strenuous repetitive and heavy lifting  activities is not advised following shoulder replacement surgery and places the hardware components in the shoulder at risk for loosening and failure. It is reasonable to expect to return to a recreational active lifestyle following the successful shoulder replacement surgery.