Shoulder arthritis is the term given to the wear and tear that takes place in the ball socket joint of the shoulder over time.
It is generally more prevalent as people get older however it possible to get shoulder arthritis even if you are young.
Degenerative Arthritis
This is normal wear and tear of the shoulder joint that leads to the erosion of the smooth ‘soap-like’ cartilage lining of the ball and socket joint. It takes place over many years and can be made worse by heavy repetitive loading through the shoulder.
Inflammatory Arthritis
This is usually due to Rheumatoid arthritis, but can also include other inflammatory conditions such as Psoriatic arthritis and Ankylosing Spondylitis. The body’s own immune system attacks itself and one of the victims is the shoulder joint. This is a very aggressive form of arthritis and if not controlled with medication can lead to rapid destruction of the joint.
Post-Traumatic Arthritis
This is seen in younger patients who have suffered an injury to the shoulder such as a fracture or a dislocation. The effects are seen several years after the injury and frequently come on slowly in the period following the traumatic event.
Painkillers
In the first instance simple analgesia in the form of paracetamol and ibuprofen should be taken.
Injection
A steroid injection into the shoulder can give temporary benefit.
Keyhole surgery
This can give short lived benefit but cannot fully address the basic problems of arthritis.
Shoulder Replacement
If you fulfill the necessary criteria then a shoulder replacement may be the best option. This is the best option if you have exhausted all the above options and do not foresee yourself doing any heavy manual activities after the operation has been performed.
There are 2 types of Shoulder Replacement
Anatomic Shoulder Replacement
In essence the normal anatomy of the shoulder is maintained. The ball is replaced with a metal ball and the socket is replaced with an extremely hard wearing plastic liner. This technology has been proven in Total Hip replacements for many years. It is now become popularised in the shoulder. For you to be able to have an Anatomic Shoulder Replacement you must have completely intact Rotator Cuff Tendons.
Reverse Shoulder Replacement
If you have torn your rotator cuff tendons then you will be a candidate for Reverse Shoulder Replacement. This is now the most common replacement performed in the UK with approximately 70% of all Shoulder Replacements being a Reverse prosthesis. In this system the ball and socket are switched around so that a metal ball is placed where your socket is and a plastic socket is implanted where your ball is.
Aftercare
Following the operation, you will normally have a bulky dressing covering your wound. This is then removed to reveal the sticky dressing at 48 hours until 14 days following your operation. The stitches will dissolve and do not require removal. You will require a wound check either at the hospital or your GP practice at 14 days.
For the first few weeks you will perform gentle mobility exercises and not push too far. You will be in a sling for anything for 2-6 weeks depending on which replacement was implanted and the quality of bone encountered during the operation. Between 6-12 weeks you will be pushed to regain all your mobility and after 12 weeks the focus will be strengthening the muscles around the shoulder. It can take from 6 weeks to 12 months to fully recover from the surgery. Every patient is different hence the large variation of
rehabilitation time. You can continue to make improvements for 12 months after your operation and at this point will know the final outcome of your surgery.
Dislocation
The ball can pop out the of socket. This can happen if the implant is too loose or you have a fall. It can also be a sign of underlying infection.
Fracture
As the prosthesis is implanted the bone is susceptible to fracture especially if it soft / osteoporotic.
Wear
As with any replacement the metal can wear out the plastic over time.
Revision Surgery
If any complications do occur, then you may require further surgery.
Stiffness
Due to pain after surgery, patients may be reluctant to perform their exercises. If you do not gently rehabilitate your shoulder it can become stiff and you can develop a frozen shoulder.
Anaesthetic Risk
Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.
Infection
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Nerve Injury
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
