Shoulder replacement surgery, also known as shoulder arthroplasty, is a procedure in which the damaged parts of the shoulder joint are surgically removed and replaced with synthetic materials (prosthesis). This procedure is commonly used to treat severe arthritis that causes significant pain in the shoulder joint.

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Should you have a Shoulder Replacement?

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The decision to undergo shoulder replacement surgery should be made after a thorough assessment and discussion with your orthopaedic surgeon. Ultimately, the decision is yours to make, and you should carefully consider all the information provided during the consultation, including the expected benefits, risks, and alternative treatment options.

The surgery can be performed under general anesthesia, regional anesthesia, or a combination of both. There are various techniques for shoulder replacement, but the general procedure involves making an incision at the front of the shoulder and removing either just the ball (head of the humerus) or both the ball and the socket (glenoid cavity). The new ball is typically made of metal, while the socket is typically made of plastic. The prosthesis is securely fitted into the bone and anchored in place with bone cement.

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After the surgery, the incisions are closed and a wound dressing is applied. You may be fitted with a sling and body belt for support. Following surgery, Dr Kilian will provide you with post-operative care instructions and a rehabilitation plan to aid in your recovery. It's important to follow these instructions carefully for optimal healing and outcomes. Overall, shoulder replacement surgery is a complex procedure that requires careful consideration and guidance from a qualified healthcare professional. Consult with Dr Kilian to determine if it's the right option for you.

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What is a Reverse Shoulder Replacement?

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Reverse shoulder replacement is a surgical procedure that involves replacing the damaged parts of the shoulder joint with synthetic materials (prosthesis), but with a unique approach compared to traditional shoulder replacement. In reverse shoulder replacement, the plastic cup is used to replace the ball, while the metal ball replaces the socket.

Reverse shoulder replacement is typically recommended for individuals who have a massive irreparable rotator cuff tear, rotator cuff tear arthropathy, or shoulder arthritis in the absence of a functional rotator cuff.

The surgical process of reverse shoulder replacement is similar to traditional shoulder replacement. It can be performed under general anesthesia, regional anesthesia, or a combination of both. After your shoulder is cleaned and prepared for surgery, Dr Kilian makes an incision at the front or top of your shoulder, and gently moves aside soft tissue to expose the shoulder joint. The top of the scapula and the ball of the humerus are then removed, and a new ball is attached to the scapula while a cup on rod is inserted into the shaft of the humerus. The prostheses are anchored in place.

Once the incisions are closed and a wound dressing is applied, you may be fitted with a sling and body belt for support. Dr Kilian will provide post-operative care instructions and a rehabilitation plan to facilitate your recovery. It's crucial to carefully follow these instructions for optimal healing and outcomes.

Reverse shoulder replacement is a specialized procedure that may be recommended for certain individuals with specific shoulder conditions. Consult with Dr Kilian to determine if it's a suitable option for you.

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What is a Rotator Cuff Tear?

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A rotator cuff tear refers to damage to the group of muscles and tendons that surround and stabilize the ball and socket shoulder joint. The rotator cuff is comprised of four muscles that allow for the high degree of mobility that the shoulder is known for. However, this also makes it susceptible to injury and pain.

The four muscles that make up the rotator cuff are the supraspinatus, subscapularis, infraspinatus, and teres minor, with the supraspinatus muscle being the most commonly affected. Rotator cuff tears can be caused by acute injury, degeneration, or normal wear and tear. In fact, approximately 70% of people over the age of 70 will have some form of rotator cuff tear due to the natural degeneration process.

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Symptoms of a Rotator Cuff Injury

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While some patients with rotator cuff tears may not experience any symptoms, others may experience pain and reduced range of motion. This pain is usually felt over the shoulder and can radiate down the front and outer part of the arm, often making it difficult to sleep at night. Pain is exacerbated when the arm is moved away from the body, and overhead activities can become increasingly difficult. If left untreated for a prolonged period, patients may also develop arthritis in the shoulder, requiring joint replacement surgery.

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Treatments for Rotator Cuff Injury

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Various treatment options are available for rotator cuff tears, including non-drug therapies such as physiotherapy to maintain mobility and strengthen the muscles unaffected by the tear, medications like oral painkillers and anti-inflammatories, and injections into the joint. Surgery is another option, particularly for younger patients, those with acute tears, and those who have not improved with non-surgical treatment.

It is important to note that a full thickness rotator cuff tear is unlikely to heal without surgery. However, if a patient is asymptomatic and able to use their shoulder without any difficulty, surgery may not be necessary, even with a large tear.

Rotator cuff surgery typically involves several components, including subacromial decompression, bursectomy, treatment of associated conditions like acromioclavicular joint arthritis and biceps tendinosis, and repairing the rotator cuff. Dr Kilian routinely perform this surgery via arthroscopy, a minimally invasive keyhole surgery. After trimming and mobilizing the torn tissue, it is reattached to the humerus bone through a few small incisions. This surgery is typically done under general anesthesia, and a regional anesthetic is frequently given as well. Patients typically need to stay in the hospital overnight and undergo post-operative rehabilitation.

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While rotator cuff surgery is generally safe, some possible complications may arise, such as stiffness or a frozen shoulder, which is the most common complication. There is also a risk of re-tear, which typically occurs 3-6 months after surgery. However, many patients with further tears of the rotator cuff tendon do not require surgery.

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What is Shoulder Instability?

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Shoulder instability refers to a condition where the shoulder joint is loose, and it may result in the ball of the joint slipping out of the socket, leading to shoulder dislocation. The causes of shoulder instability may include an injury that dislocates the shoulder, repetitive movements that stretch the joint capsule, or a genetic condition that causes over-elastic connective tissue.

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Symptoms of Shoulder Instability

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The symptoms of shoulder instability may manifest as frequent subluxation where the shoulder slips in certain positions, leading to pinching pain. Frequent dislocation may also occur, where the shoulder slips out completely, causing severe pain that requires medical attention to put the shoulder back in place. Numbness around the shoulder may also result from nerve damage that occurs during shoulder dislocation, leading to weakness in some of the shoulder muscles until the nerve recovers.

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Treatments for Shoulder Instability

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Shoulder instability can be treated through various methods, including non-drug therapy, medication, and surgery. Non-drug therapy involves rest, physiotherapy, and strapping. Anti-inflammatories may also be prescribed to alleviate pain and inflammation. If these non-surgical treatments do not work, surgery may be necessary.

Shoulder instability surgery involves tightening loose ligaments by attaching tissue to bone. There are different surgical techniques available, but arthroscopy, which is a minimally invasive keyhole surgery, is commonly used. Dr Kilian will evaluate your condition and discuss the most suitable treatment options with you during your visit.

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Shoulder Fractures

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Shoulder fractures can occur in any of the three bones of the shoulder – the clavicle (collarbone), the scapula (shoulder blade), or the proximal humerus (head of the upper arm bone). The course of treatment for these fractures will depend on whether the bones have been displaced or remain in their correct anatomical position. Most shoulder fractures are non-displaced and can be treated without surgery using non-drug therapy such as a sling and physiotherapy, as well as medication like anti-inflammatories.

On the other hand, displaced fractures usually require surgery to realign the bones and hold them in place while they heal.

The surgical procedure for a shoulder fracture is determined by the location and severity of the injury. Generally, the surgery involves realigning the pieces of broken bone, removing fragments that cannot be restored, and stabilizing the bones together. The fixation of bones is typically achieved with screws, plates, or pins. If you are unsure whether you need surgery for your shoulder fracture, it is best to consult Dr Kilian who will advise you on the most appropriate treatment option for your specific case.

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