What is Patient-Specific Shoulder Replacement?
Shoulder replacement, also referred to as shoulder arthroplasty, is a procedure in which the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses to restore shoulder function.
The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball-and-socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.
Shoulder replacement is a demanding procedure with a known complication rate. Most complications are connected with the malposition of the glenoid component of the shoulder. Patient-specific shoulder replacement was developed to counter this deficiency and offer increased accuracy in the placement of the glenoid component, which improves the likelihood of an optimal outcome. Patient-specific shoulder replacement is an innovative technology in shoulder replacement surgery. It is an advanced procedure using an individualized patient-specific shoulder implant for the replacement of shoulder components. The difference with patient-specific shoulder replacement from standard shoulder replacement surgery is the use of an MRI scan prior to the surgery that provides a clear view of the shape and structure of the shoulder joint, especially the glenoid component. Based on the MRI images, your surgeon calculates the precise cutting measurements that help the surgeon to remove the required amount of bone, at specific angles. This customized cut provides better implantation, more reliable alignment, and removal of less bone. Accurate glenoid component placement is of utmost importance in shoulder arthroplasty. Improperly placed implants are at risk of dislocation, increased component wear and loosening, and the need for revision surgery.
Indications for Patient-Specific Shoulder Replacement
Your surgeon may recommend patient-specific shoulder replacement for conditions such as osteoarthritis or rheumatoid arthritis of the shoulder joint when medication, injections, physical therapy, and activity changes have not helped to relieve the pain or improve shoulder function, severe shoulder joint trauma, or for a revision/failed shoulder replacement surgery.
Preparation for Patient-Specific Shoulder Replacement
The preoperative preparation is similar to most shoulder replacement procedures. But contrary to traditional techniques, patient-specific shoulder replacement involves careful planning and utilizes a series of CT scans to generate 3D images of an individual’s unique shoulder joint anatomy. These images enable your surgeon to design a personalized pre-surgical plan and patient-specific instrumentation to facilitate a more precise glenoid component positioning.
In general, preparation for patient-specific shoulder replacement may involve the following steps:
- A review of your medical history and a physical examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
- You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as they can hinder the healing process.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for Patient-Specific Shoulder Replacement
Patient-specific shoulder replacement surgery is usually performed under general anesthesia. A surgical cut is made over the shoulder to expose the shoulder joint, and the upper arm bone is dislocated from the shoulder socket. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. A patient-specific shoulder implant is then placed as per pre-surgical planning and patient-specific surgical guides. The preoperative plan and patient-specific instrumentation help to increase the procedure's efficiency, as well as preserve bone and optimize the positioning of the implant. With all the new components in place, the shoulder joint is tested through its range of motion. At the end of the procedure, muscles and other soft-tissue structures are positioned back to cover the shoulder joint, and the incision is closed with sutures and covered with a sterile dressing.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after patient-specific shoulder replacement will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital for at least 2 to 3 days before discharge to home.
- You are likely to experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
- Your arm will be secured with an immobilizer or assistive device such as a sling for the first few weeks to facilitate healing and protect the repair.
- Instructions on surgical site care and bathing will be provided to keep the surgical site clean and dry.
- Refrain from overhead activities and lifting heavy weights for the first couple of months. A gradual increase in activities over a period of time is recommended.
- You will need to take off work for at least a week to rest and promote healing.
- You will not be able to drive until you are fully fit and able to hold the steering wheel comfortably in both arms.
- An individualized physical therapy protocol will be designed to help strengthen shoulder muscles and optimize shoulder function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, returning to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Patient-specific shoulder replacement is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Infection
- Blood clots
- Injury to nerves and vessels
- Bleeding
- Instability
- Stiffness
- Swelling and pain
- Anesthetic/allergic reaction
