Shoulder and elbow joint replacement: an assessment: part 1

Shoulder and elbow joint issues can significantly impact daily life, hindering mobility and causing persistent discomfort. In the first article of a two part-series consultant orthopaedic surgeon Mr Dave Cloke discusses shoulder and elbow replacement, including process and criteria for shoulder replacement and the procedures for such injuries.

What is the process and criteria for determining if a shoulder or elbow joint replacement is necessary?

In my view, shoulder or elbow joint replacement is never necessary as such; it is a decision that should consist of assessing the risks and benefits and is very much an individual choice for each patient. While it aims to alleviate persistent pain, it's essential to understand the reality of the surgery: it is not a guaranteed solution, it is not a quick fix, and it carries inherent risks. This procedure is significant, with potential implications for overall health and even life, requiring a considerable recovery period.

Complications such as infection, dislocation, nerve and blood vessel damage, and eventual joint deterioration necessitating further surgery are possibilities. Moreover, the likelihood of needing additional procedures increases over time, particularly if you undergo joint replacement at a younger age. Before committing to surgery, alternative options like pain management and injection therapies should be thoroughly discussed.

Can you explain the types of shoulder and elbow joint replacement procedures, and how they are performed?

Shoulder replacements:

The most commonly used are anatomical or reverse total shoulder replacement.

An anatomical replacement is typically chosen when the rotator cuff tendons are intact, allowing for normal shoulder movements. In this scenario, the top of the arm bone and the socket are substituted with metal and plastic components.

On the other hand, a reverse replacement involves a true ball and socket replacement, which becomes necessary when the rotator cuff tendons are absent, resulting in abnormal shoulder movement. This approach allows the other muscles surrounding the shoulder to function properly. Attempting an anatomical replacement in such cases poses a significant risk of failure.

Additionally, partial replacements, although less common, are occasionally performed for fractures and arthritis. However, due to the increasing success rates of total shoulder replacements, partial replacements are becoming less frequent.

Elbow replacement:

In cases of arthritis, total elbow replacements are consistently recommended. They are specifically optimised for older individuals with inflammatory (rheumatoid) arthritis, yielding the most favourable outcomes. However, in younger individuals, especially men, who suffer from osteoarthritis, the outcomes are less favourable.

Occasionally half replacements or radial head replacements are used for fractures.

If you would like to book a consultation with Mr Cloke, do not hesitate to do so by visiting her Top Doctors profile today