Total shoulder replacement is ideal for patients with shoulder joint arthritis with an intact rotator cuff and without significant glenoid wear. Many patients with shoulder arthritis can be managed without surgery; however, when nonoperative treatment has been exhausted surgery is a reliable option to restore function and relieve pain. The latest advances with 3D planning and printing, computer navigation, and patient specific instrumentation allow for accurate placement of components leading to improved outcomes for patients.
A total shoulder replacement involves replacing the arthritic shoulder joint surfaces with a highly polished metal ball attached to a short stem and plastic socket which is implanted on the glenoid.
Essentially the abnormal surfaces (where the cartilage has worn away resulting in arthritis) are removed and replaced with a prosthesis (artificial joint). The anatomical arrangement and biomechanics of the shoulder are not changed – hence this is also called an anatomical shoulder replacement. The only caveat is that an anatomical shoulder replacement requires an intact and good quality rotator cuff to continue to function.
Dr Pant almost always uses the “stemless” anatomical shoulder replacement to minimise bone loss from the humerus, reduce blood loss, improve efficiency, and make any future revision surgery easier. He also uses computer navigation and 3D planning for all total shoulder replacements.
The decision to have shoulder replacement surgery is unique to each patient. It is a shared decision between you (patient), your family, your local doctor, and your orthopaedic shoulder surgeon.
There are several reasons why you may be a good candidate and be recommended a shoulder replacement:
Computer navigation and 3D planning has revolutionised shoulder replacement surgery. It provides improved accuracy and precision during surgery.
Dr Pant will upload your recent CT scan to a special planning software program. 3D measurements are taken of your shoulder, the exact wear pattern is analysed, the correction is planned and the “virtual” prosthesis can be implanted on the computer.
Essentially the shoulder replacement is done on the computer first. Once Dr Pant is happy with the position of the implants, then custom patient-specific instruments are ordered (from the prosthesis company) for the day of surgery. Because the operation has already been done virtually, most of the workflow during the case is more efficient and predictable. Surgery time and blood loss are reduced, and the implant position is more accurate and reproducible, leading to better functional results.
There are three essential components to a good outcome from surgery:
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
After the surgery you will be in a sling and protect your shoulder to allow the shoulder to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.
The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the shoulder begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 12 weeks post Total Shoulder Replacement surgery.
A sling is required for the first 6 weeks after your surgery; the sling is worn for a further 6 weeks outside of the house (to remind others you have had shoulder surgery). The type of sling is selected specific to you and your shoulder surgery:
Driving after shoulder surgery
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
The risk of complications after a Total Shoulder Replacement is 1-2 % in the Sydney Shoulder Unit experience. General risks include:
Specific risks relating to a Total Shoulder Replacement include:
Patients who smoke, use tobacco products, have diabetes, or are elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing. Most healthy patients, however, cope well with shoulder replacement surgery and are unlikely to have complications.
The latest advances in computer navigation, 3D planning and printing, and patient-specific instrumentation allow for accurate placement of components resulting in superior radiographic and functional outcomes for our patients.
Sydney Shoulder Unit is a high volume shoulder practice that performs a large number of shoulder replacements each year with consistent outcomes for our patients.
When carried out carefully Shoulder Replacement is a safe and reliable procedure. The Sydney Shoulder Unit revision rates are some of the lowest in the world.
Australian Orthopaedic Association National Joint Replacement Registry Data (Individual Surgeon Reports) shows that Dr Pant’s revision rate for shoulder replacements is currently 0.00% (as of 2021); the national average is 1.06%. This includes Total Shoulder Replacements, Reverse Shoulder Replacements and Shoulder Replacements for fracture.
This 70 year old lady presented with many years of shoulder pain. With the pain affecting her sleep and ability to undertake activities of daily living. Having trailed multiple cortisone injections over the years and an intense program of physiotherapy, she was at the end of her tether.
Plain x-rays demonstrated end stage advanced osteoarthritis. MRI scan demonstrated an intact Rotator cuff – which is required for the “anatomical” total shoulder replacement to function well.
CT scan with 3D planning was used to order “Patient Specific Instrumentation” for her stemless shoulder replacement.
Dr Pant almost always uses the “stemless” anatomical shoulder replacement to minimise bone loss from the humerus, reduce bone loss, improve efficiency; and make any future revision surgery easier.
The surgery was carried out as planned on the computer and the new shoulder was implanted using custom 3D printed targeting guides. She stayed overnight in hospital and was discharged home the following day. X-rays taken the following day after surgery shows a well positioned prosthesis.
She underwent a standard post shoulder replacement rehabilitation pathway using the JPL method – commencing passive range of motion at 2 weeks post surgery. By 6 weeks she reported the old arthritis pain and the post surgery pain had all settled. At 3 months she had close to full passive range of motion and commenced a light strengthening program under the guidance of her physiotherapist.
She is now pain free and delighted with her new shoulder joint.
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