Shoulder Replacement Specialist in Santa Clarita, Encino, New Hall, Westlake, and Thousand Oaks, CA
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. Dr. Daniel Acevedo provides expert diagnosis and individualized non-operative and operative treatments for the shoulder including shoulder joint replacement in Santa Clarita, Encino, New Hall, Westlake, and Thousand Oaks, CA. Dr. Daniel Acevedo also provides highly specialized care during and after surgery. Contact Dr. Daniel Acevedo’s team for an appointment today!
Description of Shoulder Replacement
During a shoulder replacement or arthroplasty, the surfaces of the shoulder joint, i.e., the ball and socket, are removed and replaced by implants. Just like in hip and knee replacements, the shoulder joint now moves by having a metal implant glide against a plastic liner. This improves pain by reducing the friction and inflammation caused by bone on bone contact.
Many different implant companies, implant configurations and implant designs are available. The exact type of implant used is based on the discretion of the surgeon and depends on the reason you are having this type of surgery.
Total Shoulder Arthroplasty
The most commonly used designs are referred to as an Anatomic Total Shoulder replacement, where the ball is replaced by a metal ball connected to a metal stem that goes down the center of the bone in your arm. On the socket side, a plastic or polyethylene liner is inserted.
Figure 1 This is an example of shoulder arthritis with the rotator cuff intact ( a and b). The treatment was an anatomic total shoulder replacement ( c and d).
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Common Conditions that require Total Shoulder Arthroplasty
- Osteoarthritis: It is the most common form of degenerative joint disease and occurs as the cartilage of the shoulder joint wears away due to overuse and normal age-related changes. It is a progressive condition and unfortunately is irreversible. It can occur at any age, but more commonly affects women over age 60. In addition, it affects the soft tissues of the shoulder and you commonly find scarring or “contracted” soft tissues around the joint. It also results in the formation of bone spurs and contributes to limited motion and stiffness. This is the most common reason why patients have a shoulder replacement.
- Rheumatoid Arthritis: It is an autoimmune disease where the cells lining the shoulder joint produce inflammatory cells that attack the tendons, cartilage, and other bones. It is a form of chronic inflammation and otherwise called inflammatory arthritis.
- Post traumatic Arthritis: It occurs following a serious injury. Usually these include fractures of the ball and/or socket that cause changes in the shapes and orientation of the shoulder joint with subsequent advanced wear of the cartilage.
- Osteonecrosis: Rarely the cartilage and the bones of the shoulder may undergo a change termed Osteonecrosis. This can result from chronic alcohol use, chronic steroid use, or in patients with medical problems such as Sickle cell anemia where the blood supply to the joint is disrupted.
Reverse Shoulder Replacement
Another commonly used design is called the Reverse Shoulder replacement. In the reverse shoulder replacement, both the ball and socket are replaced. However, they are in a “reversed” position. The socket portion of your shoulder blade is replaced with a prosthetic metal sphere and the ball portion of your shoulder is replaced with a plastic cup. Reverse Shoulder replacement works by transferring more of the load to the shoulder (deltoid) muscle and less load to the rotator cuff muscles for function. The use of reverse shoulder arthroplasty in the United States has increased over the last 10 years and is now the most commonly used prosthesis.
Figure 2 This is an example of Rotator cuff tear arthropathy. The Xray (a) shows a high riding humeral head and bone on bone arthritis. This is an AP (b) and an Axillary (c) view after a Reverse shoulder replacement.
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Common Conditions that require Reverse Total Shoulder Arthroplasty
- Rotator Cuff Arthropathy - Arthritis (loss of shoulder joint cartilage) that develops in patients with longstanding rotator cuff tears ( figure 2)
- Rotator cuff tears that cannot be repaired- Reverse shoulder replacement can be performed to stabilize the shoulder and improve motion when torn rotator cuff tendons cannot be repaired- either due to the size of the tear, degree of deterioration, or failed prior rotator cuff repair surgery. Reverse shoulder replacement is especially effective in this situation when associated with severe pain and/or the inability to raise the arm overhead in elderly patients
- A previous shoulder replacement that was not successful
- Chronic or long standing shoulder instability (ball-and-socket joint is unstable)
- Reconstruction of Acute Proximal humerus fractures
Figure 3 This is a Proximal humerus fracture dislocation with the Humeral head displaced into the axilla(a) . This was treated with a Reverse shoulder replacement ( b and c)
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C - Patients with malunited proximal humerus fracture that were initially treated without surgery.
Figure 4 a and b. This is a Mal-united proximal humerus fracture that was painful, stiff, and non functional. This was treated with a reverse shoulder replacement using a revision type stem( c and d)
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As fellowship trained shoulder specialist Dr Acevedo often performs complex shoulder replacements that require preoperative planning. A CT scan may be ordered prior to choosing the specific type of implant that is used. This CT scan needs to be performed with specific parameters and should be ordered by Dr Acevedo so it is ordered correctly. After your CT scan has been completed, Dr Acevedo used computer software to perform 3d planning to precisely choose the type of replacement, the size of the implants, and the precise position they will be implanted in surgery. This allows for decreased surgical time and improved accuracy in surgery to improve long term outcomes and minimize complications.
This is an example of a Reverse shoulder planning for a patient matched implant.
A custom implant can also be created for patients with severe deformities.
Expected Outcome
Total Shoulder Replacement has been performed since the 1950’s. Reverse shoulder arthroplasty has been performed in the United States since 2004. Both types of implants have been proven to be very effective in relieving shoulder pain.
Most patients will also have an improvement in the ability to raise the arm overhead, but this is somewhat dependent on the age of the patient, condition being treated, strength of the deltoid muscle, and presence of some remaining rotator cuff tissue. It is realistic to expect to be able to raise the arm overhead, to reach the top of the head and the opposite shoulder in most patients. However, in some patients who have had open shoulder surgery in the past may have weakened shoulder muscles, and the ability to elevate the arm may be less predictable. Your ability to rotate the arm outward is dependent on the strength of the deltoid muscle and the presence of some intact rotator cuff tendon as well.
After a reverse shoulder replacement, most patients will lose some of the ability to reach behind the back. For most, you will be able to reach your belt line or back pocket only.
Activities after Shoulder Replacement Surgery
Most patients can be very active following a shoulder replacement. Golf, tennis, swimming and light yard work and gardening are allowed. It is generally recommended that patients do not routinely lift more than 25 pounds with the operative arm following shoulder replacement surgery. (For further questions regarding lifting, ask your surgeon.) Failure to observe this restriction can result in pain and/or early loosening of the artificial joint. While postoperative restrictions vary by surgeon, Dr. Acevedo adopts an aggressive rehabilitation approach, leveraging advanced surgical techniques and modern implants. This allows for increased use and faster recovery, enabling patients to return to their daily activities more quickly and with greater confidence. The contour of the shoulder may also appear slightly different as the deltoid muscle may appear thinner or hollower in some.
How long will my shoulder replacement last?
Patients can expect their shoulder replacement to last at least 10 years. Studies have shown that 89-93% of shoulder replacements are functioning well 10 years after surgery. The exact amount of time the shoulder replacement lasts is highly dependent on the patient, the reason for shoulder replacement, and the demands placed on the shoulder by the patient.
A shoulder replacement is best performed by a shoulder and elbow specialist with specific fellowship training in this area. This specialized training ensures the surgeon has extensive knowledge and expertise in the complexities of shoulder anatomy and the latest surgical techniques. A shoulder replacement is a life-changing procedure that significantly improves patients' quality of life by alleviating pain and restoring mobility. Dr Acevedo has performed over 1500 shoulder replacements in his early career and is a consultant for Stryker Arthroplasty. In addition he is an Active member of the American Shoulder and Elbow Surgery society which makes up the best shoulder surgeons in the country. He lectures across the country on shoulder topics and is passionate about medical education.
If you would like additional information on the treatment of shoulder conditions or to learn more about shoulder joint replacement, please contact Dr. Daniel Acevedo, serving the communities of Santa Clarita, Encino, New Hall, Westlake, and Thousand Oaks, CA.
