REPLACEMENT (Arthroplasty)

What is Shoulder Arthritis?

A condition where the cartilage that cushions the joints in the shoulder wears down over time. This often leads to pain, stiffness, reduced motion, and difficulty with everyday activities. It most commonly affects the glenohumeral joint (ball-and-socket) or the acromioclavicular joint (where the collarbone meets the shoulder blade).

When the rotator cuff is torn, it weakens the shoulder joint and can lead to shoulder arthritis over time. This specific type of arthritis caused by a long-standing rotator cuff tear is called 'rotator cuff arthropathy'.

Shoulder Anatomy Basics: 

The shoulder is a ball-and-socket joint made up of 3 bones: 

1. Humerus (arm bone)
2. Scapula (shoulder blade)
3. Clavicle (collarbone)

Cartilage covers the joint surfaces, allowing smooth movement. 

Surrounding structures, like the rotator cuff muscles and tendons, labrum, and joint capsule, are essential for stability and function.

Dr. Jazayeri’s Comprehensive Approach 

Dr. Jazayeri provides a tailored, stepwise approach to managing shoulder arthritis, beginning with non-surgical options. Surgery is rarely the first recommendation. The focus is on restoring function and relieving pain using a strategy suited to the severity of your condition.

Non-Surgical Options: 

1. Physical Therapy: Targeted exercises to maintain strength, flexibility, and shoulder mechanics.
2. Injections:
   1. Corticosteroids for inflammation and pain relief
   2. Viscosupplementation (hyaluronic acid) may provide joint lubrication
   3. Orthobiologics/ Platelet-Rich Plasma (PRP)*
   4. Orthobiologics/ Bone Marrow Aspirate Concentrate (BMAC)*

*Especially when soft tissue involvement (rotator cuff, labrum, capsule) is present without significant arthritis.

Surgical Options: 

• Arthroscopic Debridement and Comprehensive Arthroscopic Management (CAM) 

Arthroscopic debridement is a minimally invasive surgical technique used to treat early-stage or mild shoulder arthritis. The procedure involves inserting a small camera and instruments into the joint through keyhole incisions to remove inflamed synovial tissue, loose bodies, and frayed cartilage. The joint surfaces are smoothed, and any mechanical irritation is addressed, which can help reduce pain and improve motion.

For more complex cases that still fall short of requiring joint replacement, Comprehensive Arthroscopic Management (CAM) may be considered. 

The CAM procedure involves a multi-step arthroscopic approach that may include:

• Capsular release to improve range of motion
• Synovectomy to remove inflamed lining
• Chondroplasty to smooth damaged cartilage
• Removal of osteophytes (bone spurs)
• Subacromial decompression to relieve impingement
• Biceps tenodesis or/ labral treatment if pathology is present

This approach is typically suited for younger, active patients with moderate arthritis who have preserved joint space and good rotator cuff integrity, and who may benefit from joint preservation rather than replacement.

The CAM procedure aims to reduce pain, improve function, and delay or avoid the need for arthroplasty. Dr. Jazayeri will assess candidacy through a thorough exam and imaging studies to ensure optimal outcomes.

 

• Shoulder Arthroplasty (Replacement)

In advanced cases, replacing the ball and socket can significantly improve function and relieve pain.

Types of Shoulder Replacement: 

a. Anatomic Shoulder Replacement: Preserves the natural alignment of the shoulder and is typically used when the rotator cuff is intact.

In standard shoulder replacement, surgeons replace the ball at the top of the arm bone (humerus) with a metal ball, and the socket of the shoulder blade (scapula) with a plastic socket. However, this technique doesn’t work well when the rotator cuff is damaged, as it may lead to loosening of the implants.

b. Reverse Shoulder Replacement: Designed for cases with rotator cuff deficiency or significant bone loss. The positions of the ball and socket are reversed to allow other muscles (like the deltoid) to compensate for the damaged rotator cuff.

What is Reverse Total Shoulder Replacement? 

When the rotator cuff is torn, it weakens the shoulder joint and can lead to shoulder arthritis over time. This specific type of arthritis caused by a long-standing rotator cuff tear is called rotator cuff arthropathy. Traditional anatomic shoulder replacement surgery is generally not effective for treating rotator cuff arthropathy, because it relies on an intact rotator cuff to keep the joint stable. Without it, the artificial joint can become loose or unstable. As a solution, reverse shoulder replacement surgery has been developed and has proven to be both effective and reliable for these cases.

In contrast, reverse shoulder replacement ‘flips’ the design:

• The metal ball is placed on the shoulder blade (glenoid)
• The plastic socket is placed on the top of the arm bone (humerus)
• This reversed configuration allows the deltoid muscle, the large muscle on the outer shoulder, to take over much of the function normally performed by the rotator cuff, improving both movement and joint stability.

 

Individualized Planning and Technology 

Dr. Jazayeri uses a comprehensive evaluation including physical examination, muscle testing, and advanced imaging (X-rays, MRI, CT scans) to determine the optimal treatment plan (standard anatomic vs reverse shoulder arthroplasty).

If surgery is indicated, he utilizes advanced 3D preoperative planning software to customize implant selection and surgical strategy. Depending on the case, intraoperative tools such as navigation, custom implants, Patient-Specific Instrumentation (PSI) may be used to precisely execute the plan. All shoulder surgeries performed are generally done on an outpatient basis, allowing for a comfortable recovery and quicker return to activity.