You may know that arthritis causes joints to wear out. There are many different types of arthritis. For example, inflammatory conditions such as rheumatoid arthritis, post traumatic damage to the joint causing uneven surfaces, and premature wear and ‘wear and tear’ arthritis such as osteoarthritis. All have a final common pathway leading to a stiff and painful joint.
While injections and physiotherapy may control symptoms in the short and medium term, arthritis tends to be progressive and eventually a replacement may be required. The shoulder is a little different to other joints when it comes to options around arthritis. This is because the glenohumeral joint (main shoulder joint) relies heavily on soft tissue balance for stability. In fact, the most common type of arthritis we see in the shoulder occurs because of abnormal wear patterns in the joint related to large tears in the rotator cuff. This is known as rotator cuff arthropathy.
In broad terms, there are two types of joint replacement in the shoulder – anatomic and reverse. An anatomic joint replacement preserves the natural orientation and muscles around the joint. A reverse joint replacement does not require the rotator cuff to function and inverts the ball and socket arrangement in the glenohumeral joint. The most common reason for this type of replacement is cuff arthropathy.
Some disease conditions damage the soft tissue and in particular the rotator cuff muscles. In this scenario, standard joint replacements tend to wear out very quickly and reverse shoulder replacement may be a better option. Where the soft tissues are preserved, anatomic replacement (preserving the natural orientation of the joint) is possible.
There are also other elements of your shoulder anatomy and the type of arthritis which affect the above. In addition to the disease itself, patient factors (especially age and activity) have a bearing on the options available. I will discuss all these elements with you at your consultation.
Following joint replacement, good rehabilitation is key to maximising your stability and function post operatively. It is important that you engage with your physio in the post-operative phase. Most of the time, gentle motion is allowed but there will be a period during which you will need to wear a sling and limit your activities to protect the reconstruction. The duration of these limitations depends on the type of surgery involved. I can discuss this with you at your consultation and post operatively. In addition, your physiotherapist can give you guidance.
Physios: see our therapy guidelines for post-operative care