Shoulder Joint Resurfacing

What is shoulder arthritis?

The glenohumeral joint of the shoulder is where the head of the humerus (upper arm bone) and the glenoid socket of the scapula (shoulder blade) come together. Articular cartilage lines the ends of these bones within the shoulder joint.  Cartilage is a slippery white connective tissue that surrounds the ends of bones and facilitates painlessly bone on bone motion within joint movement. Shoulder arthritis is characterized by cartilage loss or damage; loss of the articular cartilage leads to painful bone-on-bone joint movement. There are many types of arthritis; each type of arthritic condition has a unique cause. Osteoarthritis is also known as wear and tear arthritis. Osteoarthritis typically occurs because of repetitive loads across a joint surface. Osteoarthritis can occur as part of the aging process, usually affects individuals over the age of 50. Autoimmune conditions (rheumatoid arthritis, psoriatic arthritis) can also result in shoulder arthritis. In these conditions, the body’s own immune system attacks and destroys the joint cartilage; the shoulder joint can be affected by rheumatoid and psoriatic arthritis. Post-traumatic arthritis occurs following a traumatic injury such as a fracture or dislocation. Shoulder arthritis, when left untreated, can cause chronic shoulder pain, joint damage, and, in some cases, loss of movement.

What is the treatment for shoulder arthritis?

Individuals with mild to moderate shoulder dysfunction associated with degenerative joint disease may benefit from conservative therapy alone. Rest, activity modification, the application of ice and heat, and non-steroidal anti-inflammatory medications (NSAIDs) can be used to control pain and decrease inflammation. Corticosteroid injections can be administered if the pain and inflammation are not relieved with oral medications. A physical rehabilitation program may also be helpful to affected patients by improving shoulder girdle strength and range of motion.

Individuals with severe shoulder pain and dysfunction associated with degenerative joint disease, and those patients who fail conservative measures, are best treated with reconstructive shoulder surgery. The goal of shoulder arthritis surgery is to resurface the bone of the glenohumeral or shoulder joint. Shoulder resurfacing or replacement surgery decreases pain, and restores function, strength, and range of motion. Total shoulder replacement has been the “gold standard” for the treatment of shoulder arthritis for many decades. Less intrusive methods of treating shoulder arthritis have been developed over the past several years, and include shoulder resurfacing. The shoulder resurfacing technique involves removing only the diseased portion of the shoulder joint and is less invasive than total shoulder replacement.

What is shoulder joint resurfacing?

Shoulder joint resurfacing is effective for the treatment of osteoarthritis or rheumatoid arthritis; this surgical procedure is also indicated for other shoulder conditions such as rotator cuff arthropathy, post-traumatic arthritis, and avascular necrosis. Shoulder resurfacing replaces the damaged surfaces of the shoulder with prosthetics designed to restore the natural curvature and glide of the joint. Doctor Riley J. Williams, orthopedic shoulder surgeon, treats patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, who have experienced shoulder arthritis and need surgical treatment.

How is shoulder joint resurfacing performed?

Dr. Williams evaluates several key factors, such as the patient’s age, medical history, and desired outcome, to determine if the patient is a good candidate for shoulder joint resurfacing. This procedure is typically done on an outpatient basis using a combination of sedation, and regional anesthesia. Once positioned, a traditional anterior incision (delto-pectoral) and approach is used to access the joint and perform the surgery.

Shoulder joint resurfacing is performed on the humeral head and the glenoid socket of the scapula. The humeral head is resurfaced using specialized surgical instruments that remove and cover the damaged area. The humeral head is prepared to receive the hemispheric, metallic implant; most the proximal humeral humerus is left intact. For the glenoid, a high molecular weight dense plastic prosthesis is used to reconstruct the shoulder socket.

What are the advantages of shoulder joint resurfacing?

Dr. Williams is a proponent of shoulder joint resurfacing in the appropriate circumstances.  Shoulder joint resurfacing is less disruptive to the local shoulder anatomy and requires minimal bony resection. Shoulder joint resurfacing patients should expect clinical outcomes that are equal to more traditional total shoulder replacement techniques.

What is the recovery period like after shoulder joint resurfacing?

Most patients can expect a return to normal daily activities approximately 3-4 weeks after shoulder joint resurfacing. In general, patients in New York can typically anticipate:

• Same day discharge home after the procedure or an overnight hospital stay.
• Joint immobilization using a sling for 2 weeks. Shoulder movement exercises are encouraged immediately after surgery. The sling is used to allow muscle-tendon healing following the resurfacing procedure. Heavy lifting is discouraged during the early stages of recovery.
• Post-surgical pain and inflammation are controlled with a combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). Dr. Williams may prescribe stronger pain medication to be taken as directed.
• The key to a successful recovery following shoulder joint resurfacing is adhering to and completing the physical rehabilitation program designed by Dr. Williams. The physical therapy program will be aimed at improving the mobility and strength of the shoulder muscles. Physical therapy typically lasts 2-3 months following the shoulder resurfacing procedure.

For more information on shoulder joint resurfacing, or to discuss your shoulder osteoarthritis treatment options, please contact the office of Riley J. Williams, MD, orthopedic shoulder doctor at the Hospital for Special Surgery (HSS), serving Manhattan, Brooklyn, New York City, NY and surrounding areas.