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I went to see an orthopedic surgeon about getting a shoulder replacement. I couldn't believe all the fuss for a simple shoulder surgery. There were X-rays, MRIs, CT scans, and tests galore. I'm thinking maybe I should just look for an old-time doc who will take the old one out and put a new one in. Do I really need all this prep work?

Today, there are more than 70 different shoulder systems on the market. The surgeon must evaluate carefully which option might work best for different types of patients. Sometimes there's really more than one that could work. So, the surgeon must examine each patient carefully in making that final decision as to which one to choose. The surgery can be very complicated. Multiple factors must be considered such as the patient's age, underlying pathology, condition of the rotator cuff (muscles around the shoulder), and current/desired level of function. Shoulder replacements are indicated when pain is disabling and loss of motion and strength leaves the person unable to complete daily tasks and activities. Most patients who need a shoulder replacement have arthritis either from age-related degeneration (osteoarthritis) or from a previous injury (posttraumatic arthritis). Sometimes, there's been a history of fracture, tumors, severe rotator cuff damage, and even a failed first shoulder replacement surgery. Bone loss and soft tissue damage can contribute to making surgical reconstruction a very complex project. Without adequate bone mass and sufficient muscle strength, the implant may loosen, which can lead to implant failure. The surgeon will do everything possible to prevent complications and implant failure. Patient satisfaction is of utmost importance. It's nice to reduce and even eliminate pain, but it's far better to do so while restoring motion and function. No one can argue with that! Pre-operative planning goes a long way toward ensuring the right procedure for each individual and minimizing postoperative problems.

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