Today’s patients with shoulder arthritis are fortunate to have several surgical options. If necessary, 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, the patient’s normal anatomy is preserved. The prosthesis can be fit to the patient 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.
Joint resurfacing has been around since the early 1980s. That gives us 30-years of data to examine in order to see how well this technique is working. And in this study, one surgeon from England reviews studies published on this topic along with the results of his 340 patients who had this procedure done.
The patients in the study ranged in ages from 37 to 89 years old but the average age was 70 years old. The underlying diagnosis was rheumatoid arthritis or osteoarthritis. Follow-up was possible for at least four years and some patients were in the study for as long as 16 years.
They found that the patients who had the best results had an intact rotator cuff and a diagnosis of osteoarthritis. Overall patient satisfaction was high with 94 per cent of the patients saying their shoulders were “better” or “much better” than before resurfacing.
The results were compared with a group of patients who had a total shoulder replacement. The surgeon reports equally good results between the two groups with far fewer complications in the joint resurfacing patients. Total shoulder replacement has a greater risk and incidence of infection and bone fractures.
The surgeon suggested that his method of balancing the soft-tissue around the shoulder prevents erosion of the shoulder socket (glenoid fossa). By releasing some of the soft tissues, the humeral head can be realigned to fit in the center of the socket where it functions best. Glenoid erosion is more likely when there is a soft tissue imbalance remaining after joint resurfacing.
The author concludes that using a cementless resurfacing prosthesis for advanced arthritis of the shoulder yields very satisfactory results. There are fewer complications than with a total joint replacement. And the basic bone stock has been saved if it becomes necessary to fuse the joint or replace it with a full implant. High rates of patient satisfaction with the joint resurfacing procedure are an added bonus all around.