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I have been in a wheelchair for the last 20 years from a car accident. My lower body is paralyzed but I can use my arms to push my chair. As I get older, I'm starting to have some arthritis in my left shoulder. The pain makes it very hard to push my chair straight. Would a shoulder replacement work for me?

Osteoarthritis is the most common problem treated by joint replacement, including the shoulder joint. Patients get significant pain relief and improved function. The major contraindications for this operation are active infection in the joint or paralysis of the shoulder muscles.

Since you are a paraplegic with use of your arms, you may be a good candidate for this operation. Several factors must be considered. For example, younger patients may be better off having a partial joint replacement.

This is called a hemiarthroplasty. Usually the ball at the top of the humerus or upper arm is replaced. There are still problems replacing the socket (glenoid) side. There's a greater chance that the glenoid implant will come loose.

The condition of your rotator cuff is important. The rotator cuff is made up of four major muscles and their tendons that envelope the shoulder joint. Proper soft tissue balance is important in the success of shoulder replacement.

An orthopedic surgeon is the best one to advise you on this decision. A careful physical exam and X-rays will guide the doctor in offering you the best treatment options. Depending on your age, overall health, and lifestyle you may want to think about a motorized scooter or electric wheelchair. Saving wear and tear on your joints is important but so is the activity and strengthening you get from pushing your own chair.

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