Shoulder Surface Replacement
Other popular names
- Shoulder Resurfacing
Who does it affect?
People suffering with arthritis of the shoulder joint.
Why is this used?
The traditional shoulder replacement has a metal stem which is put down the inside of the humerus. Due to this stem there are potential problems associated with positioning the stemmed implant correctly. There are possible problems related to the use of cement used to fix the replacement. For osteoarthritis most of the time a resurfacing implant can be used rather than using a stemmed implant at the outset.
Symptoms
- Pain
- Reduced movement of the shoulder
Diagnosis
An x-ray is usually carried out. Occasional, a CT scan is also required.
Non-surgical treatment
Pain-killers and anti-inflammatory drugs will be offered.
Physiotherapy may be used to minimise the pain, strengthen the shoulder and attempt to restore a wider range of movement.
Often pain and weakness is not improved with physiotherapy or injections and at this time you will be offered surgery.
Surgical treatment
Surgery is carried out under general anaesthetic and takes about 60 minutes.
I use a prosthesis known as the ‘Copeland shoulder’. This was designed by Mr Stephen Copeland. I had the good fortune of undertaking specialist training with Mr Copeland as his Shoulder Fellow in 1996 / 1997. The implant has a long follow up and it’s success is reported in the medical literature.
http://www.biomet.co.uk/medhome-uk/extremities/shoulder/copeland
You will need to stay in hospital 1-2 days. You will return from theatre wearing a sling. The sling is worn for four weeks.
The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The dressing will be removed after 2 days. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures are trimmed at about 12 days.
Return to normal routine
Keep the wound dry until the stitches are trimmed at 12 days.
Return to driving:
You are advised to avoid driving until full movement of the shoulder has returned. . You will be given further advice about this by me or your physiotherapist.
Return to work:
Everyone has different work environments. You will be given advice on your own particular situation.
Risks
General risks (less than 1% each):
- Infection
- Neuroma (nerve pain)
- Numbness
Reflex Sympathetic Dystrophy - RSD (2% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).
Specific risks:
- Failure to completely resolve the symptoms
- Dislocation
- Wear of the implant
- Fracture around the implant
- Thrombo-embolic problems.
Results
- Mullett H, Levy O, Raj D, Even T, Abraham R, Copeland S A, Copeland Surface Replacement of the Shoulder – Results of an Hydroxyapatite-Coated Cementless Implant in Patients over 80 years of age, International Congress of Shoulder and Elbow Society, Brazil, 2007
Highlights of this study include:
Between 1993 and 2002 a series of 209 shoulders underwent resurfacing arthroplasty.
→ 180 hemi arthroplasty
→ 29 total shoulders
| Pre-Op Scored | Post-Op Scores | |
| Constant Score | 12 | 63.1 |
| Forward Flexion (degrees) | 68.1 | 115.9 |
- No humeral radio-luciencies witnessed throughout this series
- The survival rate of HA coating is 98% @ 10 years
- Kaplan Mier Analysis suggests 96.4% survival rate for the prosthesis @ 10 years
- The revision rate for the HA coated Mark IV, launched in 1993 is 2.6%. Moreover, revisions in OA are 0.7%, amounting to one revised prosthesis!