Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))
CPT4 code
Name of the Procedure:
Total Shoulder Arthroplasty
Common name(s): Total Shoulder Replacement
Technical/medical terms: Total Shoulder Arthroplasty, Glenohumeral Joint Arthroplasty, Glenoid and Proximal Humeral Replacement
Summary
Total Shoulder Arthroplasty is a surgical procedure aimed at replacing both the ball (humeral head) and socket (glenoid) portions of the shoulder joint with artificial implants. This operation is commonly performed to relieve pain and restore function in the shoulder.
Purpose
Total Shoulder Arthroplasty addresses severe shoulder problems such as advanced arthritis, severe fractures, or degenerative joint disease. The primary goals are to alleviate chronic pain, improve range of motion, and restore functional use of the shoulder.
Indications
- Persistent shoulder pain not relieved by conservative treatments (e.g., medications, physical therapy)
- Severe osteoarthritis or rheumatoid arthritis
- Post-traumatic arthritis
- Avascular necrosis of the humeral head
- Complex fractures of the proximal humerus
- Rotator cuff tear arthropathy
Preparation
- Fasting is usually required starting the night before the procedure
- Discussion around the adjustment or discontinuation of certain medications (e.g., blood thinners)
- Pre-operative diagnostic tests including X-rays, MRI, or CT scans
- Physical examination and medical history assessment
Procedure Description
- Anesthesia: Administered general anesthesia or regional block.
- Incision: A surgical incision is made over the shoulder.
- Exposure: Muscles and soft tissues are carefully moved to expose the shoulder joint.
- Bone Preparation: The damaged bone and cartilage are removed.
- Implant Insertion: Artificial components (glenoid and humeral implants) are fitted and secured in place.
- Closure: Incisions are closed with sutures, and a sterile bandage is applied.
Duration
The procedure typically lasts about 2 to 3 hours.
Setting
Performed in a hospital operating room or surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Surgical technologists
- Physical therapists (for recovery course)
Risks and Complications
- Infection
- Blood clots
- Nerve damage
- Implant loosening or wear
- Dislocation of the joint
- Post-operative stiffness
Benefits
- Significant pain relief
- Improved range of motion and shoulder function
- Enhanced quality of life and ability to perform daily activities
- Benefits can typically be realized within a few months post-surgery
Recovery
- Hospital stay: 1 to 3 days
- Use of a sling for the initial weeks
- Physical therapy: Begins shortly after surgery, continuing for several weeks to months
- Full recovery: Generally expected within 6 months to 1 year
- Restrictions: Avoid lifting heavy objects and strenuous activities initially
Alternatives
- Conservative treatments: Medications, physical therapy, and lifestyle modifications
- Partial shoulder replacement: For less severe joint disease
- Arthroscopic procedures: For less invasive interventions
- Pros and cons: Alternative treatments might offer temporary relief but are less definitive than a total shoulder replacement
Patient Experience
- During procedure: You will be under anesthesia and won't feel pain.
- After procedure: Post-operative pain managed with medications; experiencing swelling and discomfort initially.
- Pain management and comfort measures: Gradual reduction in pain through prescribed pain relief medications and physical therapy exercises.