Shoulder Arthritis

 

A ‘resurfacing’ arthroplasty of the shoulder

Osteoarthritis of the shoulder joint is quite uncommon, certainly in comparison to arthritis of the hip and knee. It can develop as a result of injury to the shoulder, particularly fractures of the humerus and may also develop as a long-term complication following large tears of the rotator cuff tendon. Arthritis developing without trauma is more common in inflammatory (rheumatoid) arthritis but primary osteoarthritis can develop in later life, more commonly in women than men.

Arthritis causes the shoulder and the upper arm to ache. Pain becomes more severe after using the arm and can be bad enough to disturb sleep. It is usually more painful to sleep on the affected side. The range of movement of the shoulder is reduced and gradually it becomes more difficult to reach above the head and behind the back. The diagnosis is confirmed by the clinical history and examination and particularly by taking X-rays of the shoulder.

Treatment of shoulder arthritis is initially non-surgical. Pain should be controlled with analgesics and possibly anti-inflammatory arthritis drugs, in addition local heat around the shoulder is very helpful. Gentle exercises are beneficial to maintain shoulder movement but strenuous exercises, particularly heavy lifting, should be avoided.

If symptoms become commanding, affecting every day activities and particularly if sleep disturbance becomes an issue, surgery should be considered. The options for treatment are different forms of shoulder arthroplasty. The main alternatives are a resurfacing types of arthroplasty in which the head of the humerus is conserved, or alternatively a shoulder replacement of a more traditional design, which removes the head of the humerus and is similar to a hip replacement. In addition, the surgeon has to consider whether a total replacement is required, in which both surfaces of the joint are replaced or whether a “half” joint replacement is sufficient, termed a “hemi-arthroplasty”. The operation is usually performed under a general anaesthetic, with a two to three days stay in hospital.

As in all shoulder operations, rehabilitation after surgery is an essential part of the treatment. Regular exercise to re-establish movement and strengthen the shoulder are vital and should continue up to a year after the operation. The results of shoulder replacement are good in terms of pain relief, but the recovery of function is very much dependent upon rehabilitation and close cooperation with a physiotherapist who specialises in shoulder rehabilitation is very important.


RWN’s view

 

Over the last five years I have used the resurfacing arthroplasty of the Copeland design for shoulder osteoarthritis. I have been impressed by the results of this procedure, which is relatively less invasive than total shoulder replacement and my short term results have been satifactory. The advantage of the Copeland resurfacing arthroplasty is that the anatomy of the upper humerus is preserved, along with the muscle attachments and the orientation of the replacement is dictated by the normal anatomy. I have also found (as has been the experience of the developers of this implant) that a hemiarthroplasty is very effective in relieving shoulder pain and therefore a resurfacing hemiarthroplasty of the shoulder is my first choice in most cases of osteoarthritis of the shoulder joint.

Rehabilitation is a vital part of the treatment. The shoulder joints become very stiff with arthritis due to tightening of tissues around the shoulder joint. To some extent these changes are reversible but will require persistent exercises to “stretch” the shortened tendons and muscles around the joint in order to re-establish a good range of shoulder movement. It is necessary therefore to persevere with exercises for well over six months and it has been shown that the shoulder will continue to improve after a shoulder replacement for over a year.

The results are very satisfactory in terms of pain relief and excellent function can be regained if the patient is prepared to persevere with exercises.