Shoulder replacement surgery – called a shoulder arthroplasty – has traditionally been relegated to helping elderly patients who suffer from long-term arthritis that is leading to the deterioration of cartilage and possibly bone structure. However, doctors now see advancements in both material and technique may allow the option to be extended to select younger patients. Let’s see if you are a candidate for this type of operation.
The shoulder is a ball and socket style joint with a design that is likely not quite what most people imagine. While many envision a ball and socket as a mechanism that includes a socket wrapping almost completely around a ball, the shoulder has a ball that simply rests against a slightly concave structure, held in place by muscles and a series of tendons and ligaments. Picture a round-bottomed cup resting against an almost flat saucer, held there by rubber bands. The saucer doesn’t wrap around the cup, it provides a settling place for it and, under normal conditions, it stays where it is while allowing for a wide range of motions.
The joint, however, is not a system in which bone moves against bone. This occurs when debilitating conditions, like arthritis, become advanced. Normally, a shoulder joint includes healthy cartilage that allows for smooth motions.
Arthritis is a condition marked by painful movement owing to the deterioration of cartilage. This can occur with age, but it can also be accelerated by prolonged athletic activity. As such, some of the more dedicated athletes – because they practice or play a lot – develop arthritis prematurely.
Doctors, however, have traditionally been reluctant to recommend shoulder replacement surgery for someone who is still young. The reasons for this included the expectation that wear and tear of the replacement material, a metal ball and a plastic cup that allows for smooth motion — would eventually wear out, requiring a second operation.
Doctors at the Mayo Clinic now say that carefully selected younger patients could benefit from shoulder replacement surgery. Here are the criteria that doctors should look for when selecting a younger patient for this type of operation:
- healthy rotator cuff that can hold the new joint in place
- Healthy socket bone stock (called the glenoid bone)
- Intact deltoid muscle
- Persistent pain that does not respond well to conventional treatment
- A patient motivated to complete physical therapy for post-operative healing and restoration
Patients should be aware of the options for a shoulder arthroplasty before selecting the right procedure for them. There are pros and cons of each procedure, which should be discussed thoroughly with a physician.
The options for surgery include a traditional shoulder arthroplasty, a partial shoulder replacement in which just the ball is replaced and a reverse shoulder arthroplasty.
Doctors came to the realization that the ball, which is normally the terminal part of your arm, and the socket, which is on the proximal side, could be reversed. In fact, it is beneficial to reverse the ball and the socket in conditions in which there is a complete rotator cuff tear, which no longer functions well to hold the joint in place.
The gains of a reverse shoulder arthroplasty is better stability when there is little or no functioning soft tissue that can hold the joint together.