Total Shoulder Replacement
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Modern advancements in shoulder replacement surgery have resulted in high rates of successful outcomes for patients with osteoarthritis. It is therefore not surprising that more patients are being treated with a shoulder replacement than ever before. In fact, over the last several years, the number of shoulder replacements performed in the United States has increased at a faster rate than even hip or knee replacements.
Modern Total Shoulder Replacement surgery has shown clinical success rates of 93-95% with improvements in pain relief and restoration of shoulder function. Thus, for a patient with severe osteoarthritis of the shoulder who has failed attempts at conservative treatment, a total shoulder replacement is a remarkable surgical alternative. Following a shoulder replacement, patients are typically able to return to previous activities with improved ability. In fact, over 70% of patients treated with a shoulder replacement noted improvements in their ability to play tennis, golf, and swim. Most patients are able to return to these activities within 3-4 months. A study performed ten years ago found that it took approximately 4.5 months to be able to play a full round of golf, however, the shoulder replacement helped to improve golf scores by an average of 5 strokes.
Many patients initially fear undergoing a shoulder replacement based on anecdotal experiences of others who were treated in the past. Several recent studies have investigated the risks involved in shoulder replacement surgery. As a recent study from Johns Hopkins University illustrated, total shoulder replacement is actually safer than hip or knee replacement surgery with a 50% lower complication rate and shorter hospital stays.1 Complication rates were also 50% lower in patients treated by surgeons who perform a high volume of shoulder replacement surgeries. Patients should therefore be encouraged to seek out a shoulder specialists who routinely perform a high volume of shoulder replacement to best determine if a shoulder replacement is indicated.
Whether to proceed with a total shoulder arthroplasty should be a quality of life decision. If the patient’s quality of life is dramatically affected by shoulder pain and loss of function from arthritis, then a total shoulder arthroplasty should be strongly considered. Physicians should be encouraged to identify those surgeons who perform a high volume of shoulder arthroplasty, as these surgeons are likely best able to determine of a shoulder replacement is indicated and may perform the surgery with lower rates of complications.
References
- Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. Shoulder arthroplasty versus hip and knee arthroplasties: a comparison of outcomes.Clin Orthop Relat Res. 2007 Feb;455:183-9.
- Edwards TB, Kadakia NR, Boulahia A, Kempf JF, Boileau P, Némoz C, Walch G.A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter study.J Shoulder Elbow Surg. 2003 May-Jun;12(3):207-13.
- Norris TR, Iannotti JP.Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study.J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):130-5.
- Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2003 Dec;85-A(12):2318-24.
- Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004 Mar;86-A(3):496-505.