Shoulder Replacement

Roughly 35,000 Americans undergo shoulder replacement surgery every year. The first such operations were performed in the 1950s in patients who had sustained a severe shoulder fracture. Since then, shoulder replacement has evolved to treat a wide range of conditions, including fractures and arthritis.

When is Shoulder Replacement the Solution?

The shoulder consists of the humerous (upper arm bone), scapula (shoulder blade), and clavicle (collar bone). The ball or head of the humerous fits into the shallow socket of the scapula, or glenoid. Areas where the surfaces of the bones touch are covered in cartilage. All remaining surfaces inside the shoulder are covered with a synovial membrane, which secretes a small amount of fluid to lubricate cartilage and eliminate friction between the bones. Muscles and tendons provide stability and support.

Shoulder replacement surgery is performed when pain-relieving medications and activity changes no longer alleviate shoulder discomfort. Conditions that may necessitate the procedure include:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Post-traumatic arthritis
  • Rotator cuff tear arthropathy
  • Osteonecrosis
  • Severe fractures
  • Previous failed shoulder replacement

Options for Shoulder Replacement

Patients in need of shoulder replacement surgery have a number of options:

  • Total shoulder replacement: The arthritic joint surfaces are replaced with a metal ball attached to metal stem, and a plastic socket.
  • Stemmed Hemiarthroplasty: Only the ball of the shoulder is replaced.
  • Resurfacing Hemiarthroplasty: Replaces the joint surface of the humeral head with a cap-like prosthesis without a stem. This option preserves bone and is often utilized in younger, more active patients.
  • Reverse Total Shoulder Replacement: A metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

Shoulder Replacement Complications

As is the case with any procedure, shoulder replacement surgery is sometimes associated with serious complications, including:

  • Infection: A shoulder replacement infection may occur around the wound or deep in the joint. While minor infections may resolve with antibiotic therapy, more severe issues may require additional surgery and removal of the implant.
  • Problems with prosthesis: Revision surgery may be needed if the prosthesis loosens, suffers from excessive wear, or becomes dislocated. According to a 2016 study published in the Journal of Shoulder and Elbow Surgery, patients who underwent total shoulder replacement with short-stem devices exhibited high percentage radiolucency (tissue voids/bone loss) on imaging screens, as well as a higher overall rate of device loosening and revision surgery.
  • Nerve injury: Nerves around the joint implant can sometimes sustain damage. In many cases, these injuries improve over time and may even heal completely.

Study Suggests Reverse Shoulder Replacements More Likely to Result in Early Complications, Failures

A study published in the June 2016 issue of the Journal of Shoulder and Elbow Surgery suggested that reverse total shoulder replacements are associated with higher rates of complications and failures in the early post-op period compared to traditional total should arthroplasty. The findings were based on a comparison of 6,658 traditional procedures to 4,186  reverse surgeries performed in California from 2011 to 2013.

The analysis indicated that the all-cause complication rate at 90 days and 2-years post-op was significantly higher for patients who had undergone reverse total shoulder replacements. Patients who underwent reverse procedures also had a significantly increased risk of infection and dislocation during the early and midterm post-op period. However, failure rates for the two types of surgeries equalized at approximately the 1-year mark. Read More

Biomet Shoulder Replacement Complications Result in $350,000 Settlement

In February 2016, a $350,000 settlement was reported in a lawsuit involving complications allegedly associated with Biomet, Inc.’s Comprehensive Reverse Total Shoulder Replacement system. According to court documents filed in the U.S. District Court, District of Colorado, the case had been brought on behalf of a plaintiff who received two Comprehensive Reverse Shoulders in 2009 and 2010. Fracture of the prostheses  resulted in their eventual removal and replacement.  The lawsuit claims that the failures were the result of components named in a 2010 Biomet shoulder recall.

The case had been scheduled to go to trial on February 29, 2016, but the trial date  was vacated as a result of the settlement. Read More

  1. AAOS (2011) “Shoulder Joint Replacement”
  2. Journal of Shoulder & Elbow Surgery (2016) “Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up.”
  3. Lexus Legal News (2016) “Biomet Shoulder Lawsuit Settles For $350,000”
Last Modified: September 8, 2016

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