Sunday, June 26, 2016

Shoulder Replacement Surgery: An Overview

Shoulder arthritis is a disabling condition for many adults.  It is usually the result of wear and tear processes as we age.  Sometimes it can be set into motion earlier with recurrent shoulder instability, fractures, or genetic diseases such as rheumatoid arthritis.

The signs and symptoms include loss of motion, pain, grinding sensation, and difficulty getting a good night's rest due to pain.

Traditional nonoperative treatment often includes activity modification, NSAIDs, cortisone injections and physical therapy.  These measures are often quite helpful in the earlier stages of the disease process.

Once these measures fail, you really have two potential treatment options to provide pain relief: PRP and/or stem cell therapy OR shoulder replacement surgery.

Briefly, PRP and stem cell therapy involve injection procedures (done in our office) to decrease inflammation and turn on the reparative processes with the goal of avoiding or delaying definitive surgical management for painful shoulder arthritis and other conditions.  Treatments can involve one to three injections over the course of 3-6 months.  This is a newer treatment option that holds significant promise and we have had high patient satisfaction rates of greater than 80% achieving significant pain relief.  While there have already been numerous published studies on the subject, this is an area of abundant active research and we should have better data from high quality studies in the coming years.

Otherwise, shoulder replacement surgery is usually chosen.  Shoulder replacement surgery is a highly successful, time-tested procedure for relieving the pain from arthritis.  Patient satisfaction rates are over 90% and implant survival rates at 10 years are also typically over 90% per published data.  To achieve the best outcome, patients should seek only an orthopedic surgeon who specializes in this procedure as research has shown the best outcomes in high volume shoulder surgeons.

Shoulder replacement surgery holds a lot of similarities to hip and knee replacement surgery.  The arthritic joint surfaces are replaced with highly polished medical-grade metal alloy and plastic components.  With improved understanding and implementation of pain management strategies, some of my patients in Palm Beach County, Florida are able to go home the day of surgery.  As of today, most of my patients stay in the hospital for 1-2 days after surgery before going home.

The rehabilitation process after surgery includes use of a sling for the first 4-6 weeks, during which time a physical therapy program is started to minimize stiffness.  Return to light daily activities is typically within 2 weeks.  Return to non-contact sports such as golf and tennis can usually begin 3-4 months postoperatively.

Michael A. Cohn, M.D. 
Orthopedic Surgeon 
Shoulder to Hand Surgery 
Orthopedic Center of Palm Beach County 
(561) 967-6500