Shoulder resection arthroplasty





Definition

Shoulder resection arthroplasty is surgery performed to repair a shoulder acromioclavicular (AC) joint. The procedure is most commonly recommended for AC joint problems resulting from osteoarthritis or injury.


Purpose

The shoulder consists of three bones: the shoulder blade, the upper arm bone (humerus), and the collarbone (clavicle). The part of the shoulder blade that makes up the roof of the shoulder is called the acromion and the joint where the acromion and the collarbone join is called the acromioclavicular (AC) joint.

Some joints in the body are more likely to develop problems due to normal wear and tear, or deterioration resulting from osteoarthritis, a progressive and degenerative joint disease. The AC joint is a common target for developing osteoarthritis in middle age. This condition can lead to pain and difficulty using the shoulder for everyday activities. Besides osteoarthritis, AC joint disease (arthrosis) may develop from an old injury to the joint such as an acromioclavicular dislocation, which is the disruption of the normal articulation between the acromion and the collarbone. This type of injury is quite common in competitive sports, but can also result from a simple fall on the shoulder.

The goal of shoulder resection arthroplasty is to restore function to an impaired shoulder, with its required motion range, stability, strength, and smoothness.

Demographics

According to the National Ambulatory Medical Care Survey, osteoarthritis is one of the most common confirmed diagnoses in individuals over the age of 65, with the condition starting to develop in middle age.

As for AC joint injuries, they are seen especially in such professional athletes as football or hockey players, and occur most frequently in the second decade of life. Males are more commonly affected than females, with a male-to-female ratio of approximately five to one.


Description

A resection arthroplasty involves the surgical removal of the last 0.5 in (1.3 cm) of the collarbone. This removal leaves a space between the acromion and the cut end of the collarbone where the AC joint used to be. The joint is replaced by scar tissue, which allows movement to occur, but prevents the rubbing of the bone ends. The end result of the surgery is that the flexible connection between the acromion and the collarbone is restored. The procedure is usually performed by making a small 2 in (5 cm) incision in the skin over the AC joint. In some cases, the surgery can be done arthroscopically. In this approach, the surgeon uses an endoscope to look through a small hole into the shoulder joint. The endoscope is an instrument of the size of a pen, consisting of a tube fitted with a light and a miniature video camera, which transmits an image of the joint interior to a television monitor. The surgeon proceeds to remove the segment of collarbone through a small incision with little disruption of the other shoulder structures.


Diagnosis/Preparation

The diagnosis is made by physical exam. Tenderness over the AC joint is usually present, with pain upon compression of the joint. X rays of the AC joint may show narrowing of the joint and bone spurs around the joint. A magnetic resonance imaging (MRI) scan may also be performed. An MRI scan is a special imaging test that uses magnetic waves to create pictures that show the tissues of the shoulder in slices and has the advantage of showing tendons as well as bones. In some cases, an ultrasound test may be also be performed to inspect the soft tissues of the joint.

Prior to arthroplasty surgery, all the standard preoperative blood and urine tests are performed. The patient also meets with the anesthesiologist to discuss any special conditions that may affect the administration of anesthesia.


Aftercare

The rehabilitation following surgery for a simple resection arthroplasty is usually fairly rapid. Patients should expect the soreness to last for three to six weeks. Postoperatively, patients usually have the affected arm in a sling for two weeks. Thereafter, a progressive passive range of shoulder motion exercise is started, usually with range-of-motion exercises that gradually evolve into active stretching and strengthening. The patient's arm remains in the sling between sessions. At six weeks, healing is sufficient to encourage progressive functional use. Physiotherapy usually continues until range of motion and strength are maximized. The therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain. Heavy physical use of the shoulder is prohibited for an additional six weeks.


Risks

Patients who undergo shoulder resection arthroplasty are susceptible to the same complications associated with any such surgery. These include wound infection, osteomyelitis, soft tissue ossification, and failure of fixation (remaining in place), with recurrent deformity. Symptomatic AC joint arthritis may develop in patients who undergo the surgery as a result of injury.

Specific risks associated with shoulder resection arthroplasty include:

  • Fractures. Fractures of the humerus may occur after surgery, although the risk is considered low.
  • Shoulder instability. Early shoulder dislocations may occur during the early postoperative period due to soft tissue imbalance or to inadequate postoperative protection; late dislocation may result from glenoid cavity wear.
  • Degenerative changes. Progressive degeneration of the AC joint is a common late complication.

Normal results

Shoulder resection arthroplasty is generally very effective in reducing pain and restoring motion of the shoulder.

Morbidity and mortality rates

In a recent four-year follow-up study on shoulder arthroplasty patients, all patients experienced relief from pain. Functional improvement was good in 77% of patients. Average shoulder abduction improved from 37–79° and forward flexion from 52–93°. No deaths resulting from shoulder resection arthroplasty have ever been reported.


Alternatives

Non-surgical treatments

Doctors commonly attempt to treat AC joint problems using conservative treatments. Patients may be prescribed such anti-inflammatory medications as aspirin or ibuprofen. Treatment also may include such diseasemodifying drugs as methotrexate, sulfasalazine and gold injections. Researchers are also working on biologic agents that can interrupt the progress of osteoarthritis. These agents target specific chemicals in the body to prevent them from acting on the joints. Resting the sore joint and applying ice to it can also ease pain and inflammation. Injections of cortisone into the joint may also be prescribed. Cortisone is a strong steroidal medication that decreases inflammation and reduces pain. The effects of the drug are temporary, but it provides effective relief in the short term. Physicians may also prescribe sessions with a physical or occupational therapist, who may use various treatments to relieve inflammation of the AC joint, including heat and ice.


Surgical alternatives

Alternative surgical approaches include replacing the entire shoulder joint with a prosthesis (total shoulder arthroplasty) or replacing the head of the humerus (hemiarthroplasty).

See also Arthroplasty ; Shoulder joint replacement .


Resources

BOOKS

Friedman, R. J. Arthroplasty of the Shoulder. New York: Thieme Medical Pub., 1994.

Lajtai, G., S. J. Snyder, G. Applegate, G. Aitzetmuller, and C. Gerber, eds. Shoulder Arthroscopy and MRI-Techniques. New York: Springer Verlag, 2003.

Walch, G., and P. Boileau., eds. Shoulder Arthroplasty. New York: Springer Verlag, 1999.

Wallace, W. A., ed. Joint Replacement in the Shoulder and Elbow. London: Edward Arnold Pub., 1998.


PERIODICALS

Iannotti, J. P., and T. R. Norris. "Influence of Preoperative Factors on Outcome of Shoulder Arthroplasty for Glenohumeral Osteoarthritis." Journal of Bone and Joint Surgery 85 (February 2003): 251–258.

Mileti, J., J. W. Sperling, and R. H. Cofield. "Shoulder Arthroplasty for the Treatment of Postinfectious Glenohumeral Arthritis." Journal of Bone and Joint Surgery 85 (April 2003): 619–614.

Nagels, J., M. Stokdijk, and P. M. Rozing. "Stress Shielding and Bone Resorption in Shoulder Arthroplasty." Journal of Shoulder and Elbow Surgery 12 (January–February 2003): 35–39.

Sanchez-Sotelo, J., J. W. Sperling, C. M. Rowland, and R. H. Cofield. "Instability after Shoulder Arthroplasty: Results of Surgical Treatment." Journal of Bone and Joint Surgery 85 (April 2003): 622–631.

Sofka, C. M., and R. S. Adler. "Sonographic Evaluation of Shoulder Arthroplasty." American Journal of Roentgenology 180 (April 2003): 1117–1120.

Woodruff, J., P. Cohen, and G. Bradley. "Arthroplasty of the Shoulder in Rheumatoid Arthritis with Rotator Cuff Dysfunction." International Orthopaedics 27 (2003): 7–10.

ORGANIZATIONS

American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, Illinois 60018-4262. (847) 823-7186. http://www.aaos.org .

American Shoulder and Elbow Surgeons (ASES). 6300 North River Road, Suite 727, Rosemont, IL, 60018-4226. (847) 698-1629. http://www.ases-assn.org .

OTHER

"Arthroplasty of the Shoulder." Wheeless' Textbook of Orthopaedics. http://www.ortho-u.net/orthoo/44.htm .

"Rehabilitation After Shoulder Arthroplasty." University of Washington Orthopaedics and Sports Medicine. <http://www.orthop.washington.edu/shoulder_elbow/roughness/mana ement/rehab/01> .


Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Shoulder resection arthroplasty is performed in a hospital. It is performed by experienced orthopedic surgeons who are specialists in AC joint problems. Some medical centers specialize in joint surgery and tend to have higher success rates than less specialized centers.

QUESTIONS TO ASK THE DOCTOR



  • How can I regain the use of my shoulder?
  • What will it take to make my shoulder healthy again?
  • Why do I have problems with my shoulder?
  • What surgical procedures do you follow?
  • How many shoulder resection arthroplasties do you perform each year?
  • Will surgery on my shoulder allow me to resume my activities?


User Contributions:

jerrysealy
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Oct 12, 2008 @ 8:08 am
what would cause fluid to form on the front side of the shoulder that is to be replaced? A few months ago I fell forward and helped break the fall with right arm. The pain is more intense now, and there was no fluid prior to the fall.
kenneth coons
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Sep 9, 2009 @ 12:00 am
i had arthroplasty last week on my right shoulder. its beeb 8 days and i cannot move anything. i can barely wiggle my finers and i get this burning sensation in my forearm. howlong does the average sugery start to see positve motion? my surgery took 6 hours, they had put a new head on... closed it up---re-opened it up and put in a larger head. so the nerves were stretched for 6 hours.any info would be appreciated thank you........Kenny
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Feb 5, 2010 @ 1:13 pm
I had this removal done to both shoulders last year 6 months apart. My life is a living hell of pain, I truly do not remember the last good nights sleep. I've had to give up so much that I cannot do anymore. I hope and pray your experience is better than mine.
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Feb 10, 2010 @ 9:21 pm
I had shoulder hemiarthroplasty done when I was 46, I am now 50 and could not be happier.
Origionally I had hemicap procedure but it failed after 6 months. I then had the more permanent solution which was a hemiarthroplasty with a stem down my humerus.
I was very concerned about having the procedure at such a young age but the pain was simply to much to bear.
It soes take a long time to heal and you will have to go through quite a bit of rehabilitation but my advice is to be diligent and stick with it.
Get several opinions and google the best doctors in this field.
The results are great and I feel pretty close to normal. I can do most activities like golf swim tennis and minor lifting.
My range of motion is good but I realize I will never be 100% again.
Pain relief is really good, I only have minor pain if I leave my arm in a fixed position for a long period of time.
Good luck to all who seek this proceedure. It is scary but once you go through it I am sure you will be very pleased!
And last but not least I hope this proceedure last me the rest of my life.
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Feb 10, 2010 @ 10:22 pm
I forgot to mention my surgeon who I think is one of the best in the country.
His name is Matthew Ramsey and now practices at Jefferson in Philadelphia.
If you google him you will see that he has written many many articals on the subject and has lectured all over the world. He is a leader in the field and teaches this proceedure to medical students.
He also has a great bed side manner which is very important when you are going through major surgery.
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May 13, 2010 @ 8:08 am
I had this procedure 5 years ago at the age of 43. The cause of the pain was a sports injury suffered when I was 21. The pain got progressivly worse as I aged to the point I could not stand to lift my arm much above my waist. The recovery was very quick and within two months I was back to playing golf. Out of fear I no longer lift wieghts but instead do more cardiovascular training. I will not say that I no longer have shoulder pain but I have no physical limitations. The past year some shoulder pain has returned but is very managable. If I had it to do over again I definately would. I have read the earlier posts about the trouble with recover but I experienced none of that.
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Sep 9, 2010 @ 9:21 pm
I am due to have both shoulders done. I am an violinist, and some of the articles say that one does not get complete range of motion back. Now everything is terribly painful unless I have a steroid shot. Also, do you know anyone who had both done at the same time? How do you research good doctors and surgeons? I live in Indy.
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Jul 22, 2011 @ 9:09 am
Dear Sir/Madam,
I hope you can give me some good advice.

I sustained a comminuted fracture of the greater tuberosity of left humerous on 24th September 2010. I slipped on a wicker mat taking out the damn rubbish!
I fractured my right knee at the same time, but this is a lot better now.

I have been in agony and taking painkillers and having physiotherapy. I was unable to do much exercise for months, except gentle stretching movements. But my physiotherapist advised me, six weeks ago, to do as much as possible. So I got back on my abdoer device to get fit. A few months ago I suddenly started getting pain in my neck and ear. I duly went to my doctor who ruled out an ear infection. I had clicking in my neck but had sustained whip lash injuries ten years ago when I was hit from behind in two car accidents. Doctors told me I had degeneration of my neck vertebra. Bascially I have lived with the pain for years. But since my fall I have been having really bad headaches and ear aches. I have never suffered from ear aches before. I am now 52.

Yesterday, 21st July 2011, I went to my 8 week fracture clinic appointment and they did another x-ray on my left shoulder and were alarmed to tell me that my fracture is not healing well and that parts of the bone have been absorbed. They said how unusual this was, but couldn't really comment until I have another MRI scan. From experience this will probably take weeks to come up. I was wondering if you could advice me on supplements to take?

I am still in a lot of pain. I can't lie on my left side and have very bad sleepless nights with the pain. The Doctors kept asking me yesterday ''are you well''? I said I thought so, except for extreme tiredness and pain. I do generally ache and creak and just thought this was the ageing process. I describe my left arm ''as creaking like the Mary Rose''! Sometimes my arm feels numb and I do get pins and needles in my left hand, but only for short periods of time. I try to battle on and really thought I was on the mend and was very scared when they described the bone absorption, describing it as having disappeared, broken off.


I did have a bone density test a few months ago and was told all was okay on that front. Why should my bone be absorbing, or dissolving then?

I buy capryllic acid mainly from Biocare (Micopryl 680) to help my stomach problems. As you no doubt remember, I have an allergy to wheat and dairy products. I have been eating cow milk yogurts to add more calcium to my diet and yesterday I bought Osteocare Calcium magnesium and vitamin D3 tablets from brand name Vitabiotics. I wonder if you think these will help. A lot of medicine in Holland and Barrett is a load of rubbish, I have been reliably informed from a doctor at St George's. I would love to have your opinion. Do you think too much acid might be in my system?


Would you advice me to keep exercising?
I have been going through the menopause since 2004, and take Menosen sage drops to help with hot flushes.
I have not taken HRT because I had a breast cancer scare a few years ago.
The only think i do regularly is chew nicontinell gum to keep me off the dreaded fags. I haven't smoked for years.

I am very worried about my situation, but just have to wait until the MRI scan can give a definitive diagnosis of what my problem is.

The Doctors at the hospital did not let me see the x-rays yesterday but did appear very concerned. They told me my condition was extremely rare, without really telling me what was going on.
They did not advice me to take supplements or anything, just wait for my MRI scan to come through.

Any pointers greatly appreciated.

With kind regards


Paula Renouf
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Jul 29, 2011 @ 12:00 am
Shoulder resection arthroplasty is performed in a hospital. It is performed by experienced orthopedic surgeons who are specialists in AC joint problems. Some medical centers specialize in joint surgery and tend to have higher success rates than less specialized centers.



Read more: Shoulder Resection Arthroplasty - procedure, test, blood, tube, removal, pain, complications, infection, medication, types, risk, Definition, Purpose, Demographics, Description, Diagnosis/Preparation, .
Report this comment as inappropriate
Jul 29, 2011 @ 12:00 am
Shoulder resection arthroplasty is performed in a hospital. It is performed by experienced orthopedic surgeons who are specialists in AC joint problems. Some medical centers specialize in joint surgery and tend to have higher success rates than less specialized centers.



Read more: Shoulder Resection Arthroplasty - procedure, test, blood, tube, removal, pain, complications, infection, medication, types, risk, Definition, Purpose, Demographics, Description, Diagnosis/Preparation, .
Report this comment as inappropriate
Aug 28, 2011 @ 7:19 pm
Is there any way that I could correspond with any others that have had this procedure?
I literally pulverized my shoulder 06/16/2010 it is now 08/27/2011.On 07/01/2010 I had a titanium rod inserted into my humerous bone with an artificial male side of the shoulder joint replaced.The plan now is complete fusion of the shoulder or this resection arthroplasty.I'm now in constant severe pain with maybe 10% mobility.
Any and all feedback or comments greatly appreciated.
Killerbug
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Jun 19, 2012 @ 3:15 pm
I had complete arthroplasty of the right shoulder six weeks ago due to arthritis caused by a sports injury many years ago. Over time the cartilage wore away and the pain increased along with frequent partial separations. Drug therapies did not help and so I had the joint replaced with a stainless steel/titanium ball and a plastic socket.

There is no pain now and I have a lot of the movement restored. I rode a bicycle daily up until the surgery and I expect to resume cycling in a couple of months. I kept the arm in a sling for two weeks following surgery and only took it off to perform the at home exercises.

There is still a lot of stiffness and soreness after the exercises due I believe to the ongoing healing process of the soft tissues and tendons that were disturbed during the surgery. My surgeon is one who specializes in shoulders and does one about 30 times per year. I also had the procedure done in a hospital that only performs joint and back procedures. I spent two days in the hospital recovering to make sure pain and infections were under control.

I am quite happy with the results, happy to off the narcotic pain meds I had been on. My only real concern is that at age 58 I may have to have the joint replaced when I reach my 70's. I also an resigned to the reality that full range of motion will never be restored.
Sandra Short
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Aug 7, 2012 @ 4:16 pm
My son is autistic with severe seizures which has resulted in a dislocated fractured shoulder that the doctors don't know how to repair. He has been to the 3rd orthopaedic surgeon which advised that the joint be removed totally (no replacement) I am so disappointed I could cry.
Don't know where to turn at this point.
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Jul 26, 2014 @ 5:17 pm
I just had this kind of surgery like 5 weeks ago. still in a lot of pain. everyone said its normal but I don't think so. im in pain 24/7. cant sleep at all and its getting to me. please email me so we can talk. I need to know who is going through this also.

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