The Doctor Is In: Arthritis and Shoulder Replacement

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Mobile, Ala. (WKRG) – Dr. Trevor Stubbs of Bayside Orthopedic discusses arthritis and shoulder replacements. 

May is Arthritis Awareness Month  – for good reason. All of us know someone with arthritis: one in four adults suffer from some form of arthritis.   Is this just a normal part of aging?

Trevor: No – arthritis is a disease. As a disability – osteoarthritis sends most patients in our door. It produces pain, aching, stiffness, and swelling of the joints.   

Shoulders end up with much of the pain and discomfort that keeps us from daily activities or just the things we enjoy – and may lead to a need to replace the joint.   

** Who needs a shoulder replacement?

Shoulder replacements are the surgical treatment used for shoulder arthritis. Patients typically get a shoulder replacement once their pain and stiffness affect their quality of life and things like medicines and injections are no longer working.

** Are there different types of shoulder replacements?  Pic available for this question

The 2 most common types of replacements are anatomic total shoulder replacements and reverse total shoulder arthroplasty. ***SHOW PIC “ANATOMIC AND REVERSE TSA” AFTER FIRST SENTENCE*** In an anatomic total shoulder, the ball of the humeral head is replaced with metal ball and the socket or glenoid is replaced with a small plastic concave component. In a reverse total shoulder, those are switched with the ball going on the glenoid or scapular side and the cup like component on the humeral side.

What does the recovery usually look like after shoulder replacement?

Most people spend one night in the hospital, but it is becoming more common to do these as an outpatient procedure. Patients go home with a sling but start gentle motion right away. Patients are completely out of the sling at 6 weeks. Physical therapy is big part of the recovery, starting with motion exercises then advancing to strengthening. Most patients transition to a home exercise program from PT around 3 months and are allowed back playing sports like golf and tennis around 6 months.

How is the surgery performed?

The incision is about 4 inches on the front of the shoulder. Once the shoulder is exposed, we use instruments to remove the bone spurs and cartilage from the ends of the bone. In most scenarios, I like to have a CT scan done prior to surgery to help plan the exact locations of the implants. The implant company can make 3D models which are used in surgery to help put a central pin in exactly the correct place.  Sometimes the implants are cemented in place and other times, the bone is allowed to grow into the side of the implants.

You mentioned 2 different types of shoulder replacements. Why would you reverse or switch the orientation of the components?

The most common reasons are when the rotator cuff is torn and in revision scenarios. The reverse total shoulder doesn’t rely on an intact rotator cuff but instead uses the large deltoid muscle to power the shoulder.

How does someone get shoulder arthritis?

Someone can develop shoulder arthritis from gradually wearing down of the cartilage, from a rheumatoid arthritis, or from having a rotator cuff tear for a long period of time.  

Are there patients you see with shoulder pain that do not need a shoulder replacement?

Absolutely. There are many people with shoulder pain who have either a rotator cuff tear or tendonitis without arthritis and a lot of those people can be treated nonsurgically or with an arthroscopic procedure. Even patients with arthritis can typically have some symptom improvement with nonsurgical things like medications, therapy, or injections.

Additional facts on arthritis:

  1. 54 million men and women suffer – 1 in 4 adults. 
  2. The most common types are osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia. 
  3. The % of adults limited by arthritis has increased about 20% in the last ten years.  Can limit your ability to hold a cup, lift a grocery bag or even walk to a car.  A third of those with arthritis find it hard to bend, stoop or kneel.  One in five may find it difficult to walk three blocks.
  4. About half of adults with arthritis are working age (18-64) . Those with arthritis are less likely to be employed.
  5. What types of arthritis are there? osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia. 
  6. Can I prevent arthritis? You can reduce your risk of getting some types of arthritis by changing risk factors you can control. Risk factors you can control include overweight and obesity, joint injuries, and smoking.
  7. Adults with arthritis are more than twice as likely as those without arthritis to report an injury related to a fall.
  8. About half of adults with arthritis have heart disease/diabetes or obesity – or some limitation of their normal activities because of arthritis.
  9. Children may develop arthritis as well – Juvenile Idiopathic Arthritis (JIA) .  Signs are joint pain, swelling, stiffness and other factors. Early diagnosis is essential. 
  10. Can we cure arthritis? No… but we can manage it most importantly with physical activity.   Walking – swimming – biking are all good for arthritis and help reduce pain and improve function.  

*from the Centers for Disease Control

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