Shoulder Osteoarthritis / Glenohumeral Joint Osteoarthritis / Total Shoulder Replacement and Reversed Total Shoulder Replacement
What is osteoarthritis?
Osteoarthritis describes the the process of joint degeneration. Every joint consists of at least two bones with a cartilage surface at the end. The purpose of cartilage is to provide an excellent gliding surface with minimal friction. The cartilage surfaces are congruent and articulate with each other. Cartilage as a biological structure has a very limited ability to regenerate. It does not have any blood supply and receives its nutrition via the joint fluid, which is produced by the inner liner of the joint capsule (enclosure of the joint). Therefore cartilage is a one off supply biological structure and once its damaged due to trauma or wear & tear (degeneration) the osteoarthritis process commences. Four different grades are defined as:
- Cartilage softening
- Thinning and fissuring of cartilage
- Severe thinning and fraying of cartilage
- Large areas of full thickness defects in the cartilage with bone on bone contact
What are the signs of osteoarthritis?
Constant deep dull ache and stiffness are the key symptoms. Often the stiffness is worst in the morning and improves a little during the day. Overall function is often severely compromised by pain. Advanced cases can also be visible due to deformity.
Who gets osteoarthritis?
Osteoarthritis can be passed on in the family tree. In those patients usually more than one joint is affected. This also applies for rheumatoid arthritis, which is a different, systemic form of progressive joint destruction. Trauma also can be the reason for progressive cartilage wear. In the shoulder joint that often occurs following shoulder dislocations where the joint remains unstable and suffers from recurrent instability events. This however is a process that runs for many years before osteoarthritis symptoms occur.
How is osteoarthritis diagnosed?
The clinical examination will reveal limited range of motion and pain in certain spots. Plain radiographs will show typical signs such as narrowing of the joint space, increased density of the bone layer underneath the cartilage, cyst formations underneath the cartilage as well as bony spurs (osteophytes). CT scans are helpful to define wear patterns and deformity and ultrasound scans and MRI are able to show changes in the surrounding soft tissues as well as cartilage thickness and defects in detail.
Treatment for osteoarthritis
Osteoarthritis can be treated symptomatically with analgesics and antiinflammatory medication. Physiotherapy can be helpful in earlier stages but can also aggravate pain in advanced stages. Injections with cortisone or other medications should be abstained from. If these measures fail and chronic pain has developed a total shoulder replacement is the procedure of choice.
Surgery for shoulder osteoarthritis
It depends on the status of the surrounding rotator cuff tendons and muscles if an anatomical replacement can be used or a so called ‘reverse total shoulder replacement’ is required to control pain and restore function.
Preparing for total shoulder replacement and reverse total shoulder replacement
Prior to the procedure, we will arrange for one preconditioning physiotherapy session where we fit a shoulder immobiliser, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.
Recovery after total shoulder replacement and reverse total shoulder replacement
Following surgery the shoulder will be placed in an immobiliser. Discharge from the hospital mostly happens on the 2nd postoperative day. Physiotherapy for elbow and wrist will commence immediately and once the shoulder is comfortable we will start ranging it. There is a tendon repair that needs to be protected after the operation and therefore the sling needs to be worn for roughly six weeks. Following this you will commence a strength & resistance program and shoulder range of motion and strength will continue to improve over 12 to 18 months.