Anatomic Total Shoulder Replacement

What is an Anatomic Shoulder Replacement?

Shoulder replacement comes in two broad forms: Anatomic and Reverse.  Anatomic Total Shoulder Replacement (ATSR) is what is used for conventional arthritis as long as the patient has a healthy rotator cuff.  ATSR is the more traditional procedure and involves replacement of the worn bony ball with a metal ball and replacement of the worn socket with a surgical grade polyethylene socket.  This procedure was pioneered and perfected at Columbia’s New York Orthopedic Hospital by surgeons Dr. Bak trained with during his fellowship.  

I’ve heard of hip and knee replacement.  Is Shoulder Replacement new or experimental?

Shoulder Replacement surgery has been done since the 1950’s and has an extensive track record.  A study at Johns Hopkins University several years ago found the complication rate significantly lower than hip and knee replacement and the satisfaction rate to be higher.  Shoulder Replacement is a highly successful procedure.

It sounds like a painful procedure.

All surgery has some anticipated pain during recovery but compared with many other types of replacement, shoulder replacement involves just a minor and brief period of pain.  In fact, we are now frequently doing shoulder replacement as an outpatient procedure.  On appropriate patients a mini-incision can be used for the procedure. MCO surgeons use a muscle sparing approach for this procedure in which we go between, rather than directly through the muscles and use bone-preserving implants.  This leads to a rapid recovery of function and rapid pain relief.

How do I know I need a Shoulder Replacement?

Shoulder arthritis occurs when the smooth cartilage surface of the ball and socket wears, becomes uneven and results in a generally inflamed state of the shoulder joint.  This is usually a gradual process that occurs as a result of genetics in addition to wear and tear occurring over your lifetime.  While the process is gradual, curiously, it is common for the symptoms to have a relatively rapid onset. This can be managed (though not cured) with nonsurgical methods initially.  Physical therapy can be helpful in selected instances but typically, activity modification (rest) and anti-inflammatory medication (oral or injected) can minimize symptoms for months to years.  In select patients, platelet-rich plasma (PRP) or stem cell therapy can be effective.  When the disease begins to interfere with everyday life and function, shoulder replacement surgery is a highly successful option.  Shoulder replacement is less common than that of the hip and knee since we don’t use our arms for walking; however, replacement of the shoulder is considered to be the most successful joint replacement in orthopedics.  

What does the surgery and recovery involve?

Total shoulder replacement surgery takes approximately one hour and does require use of a sling for approximately 4 weeks after surgery.  Typically, within the first several days after surgery, pain is quite minimal.  A small window in the rotator cuff is made and use of the sling and rehabilitation focuses on protection of this window as it heals.  We use a lesser tuberosity osteotomy technique for our rotator cuff window which has been shown to provide superior strength and healing in comparison to other techniques used in shoulder replacement. Total shoulder replacement has traditionally been done in a hospital setting, however our MCO team has been pioneering an innovative approach to pain and a minimally invasive technique that has allowed us to transition many of our patients to outpatient shoulder replacement. Return to activities such as golf, tennis and swimming are permitted and encouraged roughly 3 months after surgery.

Drs. Silas and Bak have extensive experience in shoulder replacement as Motor City Orthopedics is one of the highest-volume shoulder replacement centers in Michigan.