SHOULDER ARTHROPLASTY
A shoulder replacement (or shoulder arthroplasty) is a procedure that is used to treat shoulder pain originating from a variety of causes, including osteoarthritis, rheumatoid arthritis, rotator cuff arthropathy and dislocation arthropathy, among others. The primary symptom of these conditions is pain, but they are often associated with stiffness, weakness and a loss of motion.
The first line of treatment for symptomatic degenerative conditions of the shoulder is always non-surgical. This begins with a course of rest, ice, over-the-counter anti-inflammatory medications, activity modification and in some situations, physical therapy. If these measures are not enough to relieve symptoms sufficiently, the next step is considering an injection of a steroidal anti-inflammatory medication. If all of these measures fail to address your pain, improve function and restore your activities of daily living, a shoulder arthroplasty is then considered.
The shoulder is a ball and socket joint (anatomy of the shoulder) and a total shoulder arthroplasty replaces both sides of the joint with a combination of metal and plastic. There are two primary types of total shoulder arthroplasty, the anatomic total shoulder arthroplasty and the reverse shoulder arthroplasty. Other variations of shoulder replacements exist, but they are less common in modern shoulder surgery.
3D PLANNING
Modern technology allows for surgery to begin before you even enter the operating room. Dr. Nicolay utilizes 3-dimensional images of your shoulder (obtained from a CT scan) to pre-operatively plan your surgery. By modeling your case before surgery, Dr. Nicolay is able to confirm that your bone structure is suitable for the proposed surgery, select the best implant sizes to fit your unique anatomy and improve efficiency during surgery through rigorous planning.
ANATOMIC TOTAL SHOULDER ARTHROPLASTY
The anatomic total shoulder replacement is considered when a patient has a degenerative shoulder condition that has failed non-surgical treatment measures. Careful consideration must be given before selecting which type of arthroplasty is best for an individual patient. A careful history, physical exam and imaging studies are required to determine if an anatomic total shoulder replacement is the best treatment option.
As its name implies, the anatomic total shoulder arthroplasty utilizes a component design that closely mimics a shoulder’s natural anatomy. There are three main parts in the design. The stem, the head and the glenoid (socket). The metallic stem is placed in the humerus after the arthritic bone and cartilage of the head are removed. The stem functions as an anchor to mount the metallic head to bone. Once the stem is in proper position the head is attached in an anatomic position. The arthritic cartilage of the socket is removed and resurfaced with plastic. Once complete, the new metallic head glides smoothly across the plastic glenoid. The joint is the source of pain in arthritic shoulder diseases; therefore, a shoulder replacement is an excellent option for pain relief when other options have failed.
REVERSE TOTAL SHOULDER ARTHROPLASTY
In certain clinical scenarios, a reverse total shoulder arthroplasty is the preferred option. A reverse shoulder arthroplasty also replaces both the humeral head and the glenoid, but it utilizes a spherical implant (glenosphere) on the socket and concave implant on the humerus. This ‘reversed’ positioning has beneficial mechanical properties to allow it to function well in settings where an anatomic replacement would not. The primary reasons for considering a reverse shoulder arthroplasty are shoulder pain in the setting of arthritis in addition to a rotator cuff problem, an anatomic bone deformity or severe loss of motion. In settings were the rotator cuff is not functioning properly, there is a deformity preventing the use of an anatomic implant or a patients lacks shoulder range of motion preoperatively, a reverse total shoulder arthroplasty may be indicated.
How to Choose the Best Shoulder Replacement Surgeon in Chicago?
Dr. Richard Nicolay is an orthopedic surgeon at the Illinois Bone & Joint Institute, the largest orthopedic group practice in Illinois. Dr. Nicolay completed his fellowship training in sports medicine and shoulder surgery at the Hospital for Special Surgery in New York City, the nation’s #1 hospital for orthopedics. While in New York, he also served as fellow team physician for the New York Rangers and New York Liberty. Following fellowship, he traveled abroad for a 6-week traveling fellowship and worked with world leaders in shoulder arthroplasty in both Switzerland and France. He completed his orthopedic surgery residency training at Northwestern Memorial Hospital, Anne and Robert H. Lurie Children’s Hospital of Chicago and John H. Stroger Cook County Hospital of Chicago. Currently, Dr. Nicolay sees patients in his Glenview, Bannockburn and Morton Grove offices.
Disclaimer: All materials presented on this website are the opinions of Dr. Richard Nicolay and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Nicolay for your specific case, we recommend contacting our office to make an appointment.
