GLENOHUMERAL DJD AND SHOULDER REPLACEMENT
Glenohumeral degenerative joint disease (GDJD), also known as osteoarthritis of the shoulder, is a condition characterized by degeneration or wearing away of the protective cartilage that covers the ends of your bones (articular cartilage). As a result of degeneration of the articular cartilage, the ends of the two bones rub together and form bony growths (osteophytes).
The shoulder is a ball-and-socket joint. The shoulder joint is also called as glenohumeral joint, the joint formed by glenoid and humerus bones. The shoulder joint is formed when a ball at the top of the upper arm bone, humerus, fits neatly into a socket, the glenoid, which is part of the shoulder blade.
What are the causes of GDJD?
Glenohumeral DJD is most often seen in people over 50 years. It can also develop after an injury or trauma to the shoulder. The condition may also be hereditary.
What are the symptoms of GDJD?
A person with glenohumeral DJD is likely to have tenderness and shoulder pain that aggravates during activity. Swelling of the joint may also be seen. You may hear a clicking or creaking sound as you move your shoulder.
How is GDJD diagnosed?
To diagnose glenohumeral DJD, your doctor will review your medical history and perform a physical examination of your shoulder. X-rays of an arthritic shoulder may be useful to see osteophytes and loss of joint space.
What are the treatment options?
Treatment for glenohumeral DJD includes both non-surgical treatment and surgical treatment. Non-surgical treatment includes use of anti-inflammatory medications, applying ice, moist heat to the joint, performing range-of-motion exercises and physical therapy, corticosteroid injections, and dietary supplements of glucosamine and chondroitin.
Surgery may be indicated if non-surgical treatments are not effective. Glenohumeral DJD can be surgically treated with two forms of replacement, hemiarthroplasty and total shoulder arthroplasty. In total shoulder arthroplasty, the entire shoulder joint is replaced with an artificial joint, where as in hemiarthroplasty, only the head of the upper arm bone is replaced.
Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with artificial joint parts. Shoulder joint replacement is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, avascular necrosis, and failed former shoulder replacement surgery.
During the surgery, an incision is made over the affected shoulder to expose the shoulder joint. The humerus is separated from the glenoid socket of the scapula. The arthritic part of the humeral head and the socket is removed and prepared so as to take the artificial components. The glenoid component is then pressed into the socket, and the humeral component is cemented into the upper arm bone. The humeral head component made of metal is then placed on the humeral stem. The artificial components are fixed in place. The joint capsule is stitched together. The muscle and tendons are then repaired and the skin is closed.
Risks and Complications
Possible risks and complications specific to shoulder joint replacement surgery include:
• Infection around an implanted joint
• Dislocation or instability of an implanted joint
• Fracture of the humerus or scapula
• Damage to nerves or blood vessels
• Blood clots (deep vein thrombosis)
• Wound irritation
• Arm length discrepancies
• Wearing of the joints
• Scar formation
Shoulder Joint Replacement
Shoulder Replacement Specialist in <_____LOCATION_____>
Arthritis of the shoulder can cause pain, swelling and stiffness in the joint. The condition is treated by removing the damaged articulating parts and replacing them with prostheses. <_____NAME_____> provides expert diagnosis and individualized non-operative and operative treatments for the shoulder including shoulder joint replacement in <_____LOCATION_____>. <_____NAME_____> also provides highly specialized care during and after surgery. Contact <_____NAME_____>’s team for an appointment today!
What is Shoulder Joint Replacement?
Total shoulder replacement surgery is performed to relieve symptoms of severe shoulder pain and disability due to arthritis. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.
The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.
What is Arthritis?
When the cartilage is damaged, the two bones rub against each other causing pain, swelling and stiffness of the joint. This condition is called arthritis. There are many types of arthritis. Osteoarthritis (wear-and-tear brought about by old age) and rheumatoid arthritis (autoimmune disease) are two forms of arthritis.
What are the Indications for Shoulder Joint Replacement?
Total shoulder joint replacement is a surgery indicated for conditions such as osteoarthritis or rheumatoid arthritis when medication, injections, physical therapy, and activity changes do not help relieve pain. Your doctor recommends surgery when you have the following symptoms:
- Severe shoulder pain that restricts daily activities
- Moderate to severe pain during rest
- Weakness and/or loss of motion
Preparation for Shoulder Joint Replacement
To decide whether total shoulder replacement is a good option for you, your doctor will evaluate your condition thoroughly.
Your doctor will review your medical history and perform a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI (magnetic resonance imaging) may also be performed.
Shoulder Joint Replacement Procedure
The surgery is performed under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as an open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.
The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem is gently press-fit into the humerus.
Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone.
After the artificial components are implanted, the joint capsule is stitched, and the wound is closed.
Postoperative Care for Shoulder Joint Replacement
After the surgery, medications and antibiotics are prescribed to control pain and prevent infection. Your arm may be secured in a sling or cast. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You may be able to perform gentle daily activities two to six weeks after surgery.
Risks and Complications of Shoulder Joint Replacement
As with any major surgery, there may be potential risks involved:
- Anesthetic complications such as nausea, dizziness, and vomiting
- Infection of the wound
- Dislocation, requiring repeat surgery
- Damage to blood vessels, nerves or muscles
- Failure to relieve pain
- Pulmonary embolism
- Wear and tear of the prosthesis
If you would like additional information on the treatment of shoulder conditions or to learn more about shoulder joint replacement, please contact <_____NAME_____>, serving the communities of <_____LOCATION_____>.
Revision Shoulder Replacement
Revision Shoulder Replacement Surgeon in <_____LOCATION_____>
Persistent pain, infection, stiffness, weakness, instability, hardware loosening, malposition or fracture after a total shoulder replacement may necessitate revision surgery. <_____NAME_____> provides expert diagnosis and individualized nonoperative and operative treatments for the shoulder including revision shoulder replacement in <_____LOCATION_____>. <_____NAME_____> also provides the highest level of care during and after surgery. Contact <_____NAME_____>'s office for an appointment today!
What is Total Shoulder Replacement?
Total shoulder replacement is the replacement of the head of the humerus (upper arm bone) and the glenoid cavity (cavity of the shoulder blade) into which the humerus fits, with artificial prostheses to relieve pain, swelling, and stiffness caused due to damage of cartilage at the articulating surfaces.
When is a Revision Shoulder Replacement Considered?
Total shoulder replacement usually has good results, but a revision surgery may occasionally be necessary due to persistent pain, infection, stiffness, weakness, instability, hardware loosening, malposition or fracture.
These complications occur with the formation of osteophytes (bone spurs), scar tissue, deficits in the supporting muscles, injury to nerves during surgery, soft tissue imbalance and loose bodies. Complications may also occur when the components are too large, become loose or misplaced. Inadequate participation in the rehabilitation program and overstraining the repaired tendons too early are other causes for surgical failure.
Preparing for Revision Shoulder Replacement
Before considering revision surgery, <_____NAME_____> will review your history and perform a thorough physical examination of your shoulder to identify the cause of failure and decide on the best approach to treatment.
Revision Shoulder Replacement Procedure
Revision surgery is usually performed under general anesthesia. You are positioned in such a way as to allow all possible variations in the treatment plan. Incisions are made to gain optimal access to the problem and usually follow previous incisions with extensions made as necessary.
Revision surgery involves the following:
- Impeding structures such as scar tissue are removed.
- Muscles, tendons, and ligaments that are stiff are released to improve range of motion and those that are injured are repaired using tendon grafts.
- Ill-fitting components are replaced or altered.
- Fractures are stabilized with plates, screws, and wires.
- Infections are usually treated by debriding soft tissue (removal of dead, infected tissue) and irrigation with antibiotic solution.
- In cases of chronic infections, components may need to be replaced.
- Care is taken to protect muscular and neurovascular structures whose positions may be altered because of the previous surgery.
Risks and Complications of Revision Shoulder Replacement
Potential risks and complications that may occur following shoulder hemiarthroplasty include infection, instability, fractures of the humerus or scapula, shoulder stiffness, and damage to the blood vessels and nerves.
If you would like additional information on shoulder treatments or to learn more about revision shoulder replacement, please contact <_____NAME_____>, serving the communities of <_____LOCATION_____>
Minimally Invasive Shoulder Joint Replacement
The shoulder is a ball and socket joint that allows various arm movements. The head of the upper arm bone (humerus) articulates with the glenoid cavity of the shoulder bone (scapula). The two articulating surfaces of the bones are covered with cartilage which prevents friction between the moving bones. A rotator cuff is a group of four tendons that join the head of the humerus to the deeper muscles and provides stability and mobility to the shoulder joint.
What is Minimally Invasive Shoulder Joint Replacement?
Shoulder joint replacement is a surgical procedure that replaces damaged bone surfaces with artificial humeral and glenoid components to relieve pain and improve functional ability in the shoulder joint.
It can be performed by a traditional open approach or through a minimally invasive approach. The incision of a minimally invasive shoulder joint replacement is about 5 cm compared to 17 cm with the traditional approach.
Indications for Minimally Invasive Shoulder Joint Replacement
When conservative measures such as medications, injections, physical therapy, and activity changes do not help relieve pain from conditions such as arthritis, avascular necrosis, and humeral head fractures, then shoulder joint replacement is considered as a treatment option.
The decision to perform shoulder replacement via the traditional approach or the minimally invasive approach depends on the pathology. Exposure of the glenoid is often difficult even when the incision is long as in the traditional approach. Therefore, if the pathology is such that more exposure to the joint is required for the surgical treatment then a traditional approach is preferred.
The minimally invasive approach is generally preferred when the problem can be rectified by replacement of only the humeral head such as with the following conditions:
- Shoulder arthritis with not much damage to the glenoid and with only small bone spurs
- Four-part humerus fractures with intact rotator cuff
- Avascular necrosis of the humerus, resulting in tiny multiple fractures
To determine the pathology, your surgeon orders an X-ray of the shoulder in the anteroposterior and axillary view. The axillary X-ray is especially important to check the condition of the glenoid. In case the condition is not very clear, your surgeon orders a CT scan of the shoulder to provide more detailed cross-sectional images of the bone and soft tissue of the shoulder including the glenoid.
Minimally Invasive Shoulder Joint Replacement Procedure
- The surgery is performed under sterile conditions in the operating room under regional or general anesthesia.
- You will lie in a beach chair position with the operated arm held by an arm positioner.
- A 5-cm incision is made over the shoulder joint.
- The muscle overlying the shoulder bones are cut just enough to expose the head of the humerus.
- The humeral head is dislocated and released from the capsule.
- The arthritic or damaged humeral head is cut at the neck and removed.
- The humeral component is matched in diameter and thickness to the natural humeral head.
- A bone tunnel is made in the humerus to take the humeral stem.
- The humeral stem is then inserted into the humerus. This may be press-fit, relying on the bone to grow into it or cemented, depending on several factors such as bone quality and your surgeon’s preference.
- If the glenoid also needs to be replaced, your surgeon then proceeds to the preparation of the glenoid component.
- The glenoid is sized for the appropriate implant.
- Next, the glenoid is prepared to take the artificial component by drilling holes in the glenoid to fix the plastic glenoid component.
- Bone cement is placed in the holes and the glenoid implant is inserted.
- Once the glenoid is replaced with the plastic component, your surgeon works on the humeral component.
- The correct sized metallic humeral component is then fixed to the humeral stem.
- The soft tissue covering the joint is sutured back together and the incision closed with absorbable sutures.
- An X-ray is taken to verify the correct fit (size and position) of the implant.
Postoperative Care for Minimally Invasive Shoulder Joint Replacement
After the surgery, your arm will be placed in a sling, which you will wear for 2-4 weeks while your shoulder heals. Pain medications and antibiotics are administered to keep you comfortable and prevent infection.
The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. Follow your therapist’s instructions for home exercises to achieve the best outcome.
It is critical to follow the postoperative instructions given to you by your surgical team. The postoperative instructions include the following:
- Rest your shoulder. No lifting, pushing or pulling for the first few weeks.
- Perform home exercises as advised by your therapist.
- Do not overuse your shoulder while healing as it may result in severe limitations in motion later.
- Do not drive a car for the first few weeks after the surgery.
- Avoid getting the incision wet until fully healed.
Advantages of Minimally Invasive Shoulder Joint Replacement
The benefits of minimally invasive surgery include less damage to the soft tissues and underlying muscles, enabling a faster recovery with less pain and a smaller scar. Blood loss during the surgery is also less and complications after the surgery are fewer when compared to the open technique.
Risks and Complications of Minimally Invasive Shoulder Joint Replacement
Some of the possible risks and complications of minimally invasive shoulder joint replacement include infection, nerve injury and prosthesis problems. Most of these can be treated successfully; however, prosthesis problems such as excessive wear, loosening of components or dislocation may require additional revision surgery.