II. Definitions

  1. Glenoid and humeral head replacement

III. Indications

  1. Severe Shoulder Osteoarthritis
  2. Shoulder Pain and loss of function refractory to conservative therapy or prior surgery
  3. End-stage rotator cuff Arthropathy
  4. Osteonecrosis

IV. Contraindications

  1. Recent infection
  2. Neuropathic joint
  3. Deltoid or rotator cuff complete paralysis
  4. Debilitating comorbid illness
  5. Shoulder Instability that cannot be surgically corrected

V. Efficacy

  1. Most effective and long-lasting procedure for severe Shoulder Arthritis

VI. Procedure: General

  1. Arthoplasty performed under general Anesthesia with supplemental Regional Anesthesia in some cases
  2. Minimal blood loss

VII. Procedure: Traditional Total Shoulder Total Shoulder

  1. Glenoid fossa resurfaced with solid polyethylene part
  2. Humeral head and neck replaced with metal prosthesis

VIII. Procedure: Reverse Total Shoulder Arthroplasty

  1. Ball is attached to glenoid and socket to the proximal Humerus (reverses anatomic positions)
  2. Function after reverse arthroplasty may be better than traditional replacement in specific cases
    1. Complicated proximal Humeruse Fracture in older adults
    2. Significant rotator cuff pathology would limit function in traditional replacement
      1. Deltoid Muscle becomes primary in Shoulder movement
  3. Shoulder Dislocations may occur in 4% of patients (esp. Obesity, prior dislocation)
    1. May occur within weeks of surgery (most common)
    2. Delayed dislocation may be due to glenoid bone loss, implant wear, malalignment
    3. Risk of neurovascular injury (esp. Axillary Nerve Injury)
    4. Use standard Shoulder reduction techniques if not contraindicated
      1. Refer to orthopedics after reduction (revision may be needed in up to 45% of cases)
    5. Defer reduction to orthopedics in complicated cases
      1. Periprosthetic Fracture
      2. Acromial Fracture or Scapular Fracture
  4. References
    1. Riveros (2024) Crit Dec Emerg Med 38(12): 20-1

IX. Protocol: Post-operative Management

  1. Sling used for 3-6 weeks after surgery
  2. Post-operative rehabilitation
    1. Day 1
      1. Start active range of motion of elbow, wrist and hand
      2. Start passive range of motion of Shoulder
    2. Day 21
      1. Start pulley Exercises
    3. Day 35
      1. Start Isometric Exercises

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Arthroplasty of shoulder with synthetic joint prosthesis (C0186623)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 308681004, 8020008
Dutch schouderverplaatsing
German Schulterersatz
Italian Sostituzione della spalla
Portuguese Substituição do ombro
Spanish Sustitución del hombro, artroplastia de hombro con prótesis, artroplastia protésica del hombro (procedimiento), artroplastia de hombro con prótesis (procedimiento), artroplastia protésica del hombro, artroplastia de hombro con prótesis articular sintética, artroplastia de hombro con prótesis articular sintética (procedimiento), artroplastia del hombro con prótesis articular sintética (procedimiento), artroplastia del hombro con prótesis articular sintética, reemplazo de hombro
Japanese 肩関節置換, カタカンセツチカン
French Remplacement de l'épaule
English Prosthet arthroplasty shoulder, replacement shoulder, replacements shoulder, shoulder replacement, Shoulder replacement, Prosthetic arthroplasty of the shoulder, Prosthetic arthroplasty of the shoulder (procedure), Arthroplasty of shoulder with synthetic joint prosthesis (procedure), Arthroplasty of shoulder with synthetic joint prosthesis, Arthroplasty of shoulder with synthetic joint prosthesis, NOS
Czech Náhrada ramenního kloubu
Hungarian Vállízület pótlás

Ontology: Total shoulder replacement (C0186657)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 48918-00
SnomedCT 150154008, 42262007
English Prosth total arthropl shoulder, TSR - Total shoulder replacemt, shoulder arthroplasty total shoulder replacement, shoulder arthroplasty total shoulder replacement (treatment), total shoulder replacement, Total arthroplasty of shoulder, total shoulder arthroplasty, replacements shoulder total, Prosthetic total arthroplasty of the shoulder (procedure), Total shoulder replacement, Prosthetic total arthroplasty of the shoulder, TSR - Total shoulder replacement, Total shoulder replacement (procedure)
Spanish reemplazo total de la articulación del hombro, reemplazo total de la articulación escapulohumeral (procedimiento), reemplazo total de la articulación escapulohumeral

Ontology: Arthroplasty of the shoulder (procedure) (C0186662)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 U004741
SnomedCT 150153002, 119636002, 86784007, 239468007, 217225009
Italian Artroplastica della spalla
Japanese 肩関節形成, カタカンセツケイセイ
English Arthroplasty of the shoulder (procedure), shoulder repair (treatment), shoulder arthroplasty (treatment), shoulder repair, shoulder arthroplasty, repair shoulder, Shoulder: Repair, Shoulder arthroplasty, Arthroplasty of shoulder (procedure), Shoulder repair (procedure), Arthroplasty of the shoulder, Repair of shoulder, Repair of shoulder (procedure), Arthroplasty of shoulder, Shoulder repair, Arthroplasty of shoulder, NOS, Repair of shoulder, NOS, Arthroplasty of shoulder (procedure) [Ambiguous]
Czech Umělá náhrada ramenního kloubu
Hungarian Váll arthroplastica
Spanish artroplastia del hombro (procedimiento), reparación del hombro, artroplastia de la articulación escapulohumeral, reparación de la articulación escapulohumeral (procedimiento), artroplastia de hombro, artroplastia de la articulación del hombro, artroplastia de hombro (procedimiento), reparación de la articulación escapulohumeral, artroplastia de la articulación escapulohumeral (procedimiento), reparación quirúrgica del hombro, artroplastia del hombro, artroplastia de la articulación escapulohumeral (concepto no activo), reparación de hombro (procedimiento), reparación de hombro, Artroplastia del hombro
Portuguese Artroplastia do ombro
Dutch schouderartroplastiek
French Arthroplastie de l'épaule
German Schultergelenksplastik