Alternatives to Shoulder Replacement Perth
Alternatives to Shoulder Replacement
Exploring some of the alternatives to shoulder replacement
I would like to explore some of the alternatives to shoulder replacement. However, I should, at the start, admit my biases. I am an arthroscopic and reconstructive surgeon. I do not perform shoulder replacement surgery. In many ways, that places me in an excellent position to advise patients about the pros and cons of shoulder replacement surgery – I have no vested interest.
shoulder replacement alternatives | shoulder surgeon Perth
Why have I been advised to have a shoulder replacement?
The common reasons for shoulder replacement are:
- Arthritis, most commonly osteoarthritis.
Your shoulder may become arthritic as a result of genetic factors or old injuries. In particular, previous shoulder dislocation is a risk factor for developing osteoarthritis. - An irreparable rotator cuff tear.
If you have a tendon tear that is not fixable, shoulder replacement may be the preferred option. - Severe damage from fracture.
Some fractures of the shoulder joint are so severe that they are not reconstructable or may have healed with a very poor result, in which case shoulder replacement might be advised.
shoulder replacement alternatives | shoulder surgeon Perth
What is shoulder replacement hoping to achieve?
The main benefit of shoulder replacement is, like all joint replacements, to provide pain relief. Better range of movement is not necessarily guaranteed by shoulder replacement surgery. Shoulder replacement is for people who have severe and unremitting shoulder pain.
shoulder replacement alternatives | shoulder surgeon Perth
What are the downsides to shoulder replacement ?
Shoulder replacement is a big operation and as such comes with big risks. Those risks are not common or frequent but they are potentially severe. Risks include infection, instability or dislocation of the joint replacement, and damage to
nerves and arteries. The replacement has a lifespan – maybe 15 years, before it needs to be redone.
I often say to patients that one of the reasons to delay joint replacement for as long as possible is – if a cure for arthritis emerges next week, it’s too late for you once you’ve had the joint replacement. Now I’m not proposing that shoulder
arthritis or any arthritis is about to be cured in the immediate future, but the concept still stands. New technologies are emerging all the time.
One technology that frequently gets brought up in consultations is stem cell treatment. It is an exciting area of research. However, to date, no studies on animals or humans have shown that stem cells can reverse osteoarthritic damage
or cause new joint surfaces to grow. The simplest explanation for this is that the original cells in the joint wore away for a reason. Injecting new cells won’t result in any changes because those reasons, whatever they might be, still exist.
There are many steps that need to be solved before stem cells are viable treatments for arthritis. We need to work out how to make the stem cells turn into “chondrocytes” which grow the new surface. Those chondrocytes then need to embed on the joint surface, and this in itself is a major challenge. An arthritic joint surface is very much like a billiard ball – it is a hard polished surface, inhospitable and not ready to accept new cells. Thirdly, we need to get those cells to proliferate and grow a new joint surface.
So stem cell treatment for arthritis of any joint is still some way off.
shoulder replacement alternatives | shoulder surgeon Perth
Can I get pain relief without undergoing shoulder replacement?
The answer to that is “maybe”. However, like a lot of medical therapies, the key to success is patient compliance. It is very easy to sign up for an operation. The non-operative treatment of osteoarthritis is, however, labour intensive and requires a significant commitment. You have to do the hard yards. Here is a list of the alternatives that might be considered:
Simple analgesics and natural therapies.
I hear many patients say that Panadol doesn’t work for their pain. However, Panadol is a very short acting drug. For it to work correctly, it needs to be taken regularly. That means Panadol Osteo, 6 tablets a day or ordinary Panadol, eight tablets a day. Panadol is very safe, so long as you do not have liver disease. Panadol is still the mainstay of our management of arthritic pain, and can be taken on a daily basis, indefinitely.
Anti-inflammatories are also very effective for arthritic pain, but have side effects, including an impact on kidneys and blood pressure as well as reflux. Therefore they are an intermittent drug, not an everyday drug. A good strategy is to take anti-inflammatories on active days such as golf or tennis.
Of the natural therapies, there is not much supportive evidence for glucosamine or fish oil in the management of arthritis. However turmeric is almost certainly a natural anti-inflammatory and I would recommend a trial.
Exercise.
This is an excellent way to manage pain in general. It promotes natural endorphins which counteract pain.
A specific set of exercises for the shoulder, often referred to as “a rotator cuff stretch and strengthen program”, is an important part of managing all shoulder problems. I would recommend seeing a physiotherapist for instruction in the exercises. Once you’re familiar with the exercises the physio can upgrade them intermittently
Injections.
There are various injections for arthritis most commonly used in the knee but also applicable to the shoulder. This includes cortisone injections, lubricant or plasma (PRP).
Nerve blocks.
A pain specialist can undertake a suprascapular nerve block (rhizotomy) to provide pain relief on an enduring basis.
Other surgical procedures.
a) Surgical rhizotomy. The suprascapular nerve can be cut permanently and this provides pain relief. This is only applicable in certain patients.
b) Shoulder arthroscopy. Releasing the capsule of the shoulder joint can improve the range of movement. Removing a spur in the shoulder and tidying up the tendon tear and bursitis can in some cases provide pain relief with minimal risk.
c) Tendon transfers and joint soft tissue reconstruction (superior capsular reconstruction). These procedures are applicable in a limited number of patients where the underlying problem is an irreparable tendon tear. Results are only moderately good at best.
d) Subacromial balloon spacer. This is a newer device that is applicable for irreparable tendon tears which places an inflatable saline filled spacer between the shoulder ball and the bone above it, the acromion. This reduces the bone-on-bone contact and repositions the shoulder ball in the socket appropriately. That facilitates rehabilitation and more normal shoulder function.
shoulder replacement alternatives | shoulder surgeon Perth
Conclusion
As you can see, there are a large number of options for the non-operative management of shoulder arthritis, and some surgical alternatives to shoulder replacement. Usually, it’s a case of combining multiple modalities to get a satisfactory outcome. Remember, when the alternative is shoulder replacement, we are not aiming for a cure, we are trying to get to a level of function that
meets your requirements, and adequate pain relief.
Dr David Colvin