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I just can't decide what to do for my shoulder arthritis. One surgeon says I need a total shoulder replacement. Another tells me I could have a joint resurfacing procedure done and save enough bone to put the total joint replacement off for quite some time. How is a patient supposed to decide?

Today's patients with pain, stiffness, and loss of motion and function from shoulder arthritis do have some choices that weren't available 30 years ago. As you have found out, a total shoulder replacement can be done. But even better is a procedure called shoulder resurfacing that makes it possible to get a "new" shoulder without losing much bone and without replacing the whole thing. Instead the damaged surfaces of the joint are covered with a resurfacing prosthesis or implant. In addition to saving bone there are many other advantages to the resurfacing technique. For example, your normal shoulder joint anatomy is preserved. The prosthesis can be fit to you instead of the other way around. The natural angle of the humeral (upper arm) bone is maintained. The cap that fits over the round humeral head has a peg that sets down into a hole drilled in the bone. The bits of bone taken from the hole are used to patch defects under the humeral cup. This means that the joint surface can be smoothed out and no bone is lost. Joint resurfacing isn't possible for everyone. The surgeon must evaluate each patient individually to determine all possibilities. Joint resurfacing is most likely an option when there is still some joint surface left to work with. At least 60 per cent of the joint surface must be present. The rest can be treated with bone graft or bone graft substitute. Joint resurfacing can be offered to the patient who has an unstable joint from rotator cuff tears or insufficiency. The main goal of joint resurfacing for deficient rotator cuff disease is pain relief. Improved shoulder motion isn't a main feature of this surgery without intact muscles to move the arm. Anyone with pain, stiffness, and loss of shoulder motion from rheumatoid arthritis or osteoarthritis may be a good candidate. Anyone with shoulder joint infection, too much bone loss or surface erosion, or arm paralysis would not be considered for joint resurfacing. It's likely the surgeon who suggested joint resurfacing mentioned some reasons why you might be a good candidate for this procedure. Before making a final decision you can always ask the surgeon who suggested a total shoulder replacement about the idea of joint resurfacing. Or you could even seek a third opinion from another independent orthopedic surgeon.

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