Shoulder Replacement Surgery

It is worth noting that there are many types of Shoulder Replacement Surgery, and the type performed depends on the patient’s condition. These are the three main types of surgery performed by Mr Soong Chua:

1. Stemless or Partial Shoulder Replacement (Hemiarthroplasty)
   In patients who develop arthritis at a younger age, hemiarthroplasty or partial shoulder replacement may be an option, to preserve as much normal anatomy for as long as possible. In this case, only the head of the humerus or the ball of the joint is replaced.The original glenoid or socket remains, articulating with the replacement head. Emerging materials, such as pyrocarbon, have demonstrated promising outcomes in decreasing the wear and tear of the native socket. This preservation strategy can potentially delay or entirely eliminate the necessity for subsequent surgeries.Opting for a stemless or short stem Shoulder Replacement Surgery not only conserves bone stock but also establishes a stable platform for the shoulder replacement. This can make it easier to perform a revision operation if the original shoulder replacement wears out as part of the natural course of events.
2. Conventional Total Shoulder Replacement
   A conventional or anatomic shoulder replacement replaces the ball and socket of the shoulder in their normal configuration. These types of shoulder replacements rely on the rotator cuff to provide movement and function.Provided the rotator cuff remains functional, a conventional shoulder replacement works very well at relieving pain and restoring function.
3. Reverse Total Shoulder Replacement
   Reverse total shoulder replacement surgery is specifically designed for patients with severe rotator cuff tears or chronic rotator cuff deficiency, a condition often referred to as cuff tear arthropathy. In these cases, a conventional shoulder replacement would not be optimal as it relies on a functional rotator cuff for movement. The reverse procedure addresses this by reversing the orientation of the shoulder joint, placing the ball on the glenoid (socket) side and the socket on the humeral (arm) side. This unique configuration allows other muscles to compensate for the deficient rotator cuff, restoring shoulder movement.Additionally, reverse shoulder replacements can be beneficial for patients with osteoarthritis who have pre-existing or concurrent rotator cuff issues. With over 35 years of international data, reverse shoulder replacements have shown equivalent or superior longevity compared to conventional shoulder replacements. According to the 2023 Australian National Joint Registry Report, the 14-year risk of revision surgery for a reverse shoulder replacement performed for osteoarthritis is 7.3%.

Patient-Specific Technology
Advancements in technology now enable surgeons to utilise a patient’s specific bony anatomy to plan surgeries with ‘virtual implants’ and computer-generated models. Mr Soong Chua employs this technology for all his shoulder replacement procedures, meticulously planning each surgery beforehand. Once satisfied with the virtual implant positioning, 3D printed, patient-specific models and guides are produced and used during surgery to ensure precise implantation.

Mixed Reality in Surgery
As well as patient specific guides, the latest technology allows for mixed reality to be used during surgery. With the use of a mixed reality headset in surgery (e.g Microsoft HoloLens) a virtual model can be ‘placed’ next to or on top of the actual anatomy during surgery to further enhance accuracy and improve patient outcomes. Mr Chua is among a small group of surgeons in Australia, specifically selected to use this technology.

Bone Grafting
Mr Soong Chua has extensive experience in the latest bone grafting techniques, which are particularly beneficial in reverse or revision total shoulder replacements with severe bone erosion or loss. Known as the BIORSA procedure, these techniques aim to restore normal joint mechanics more effectively, thereby enhancing movement and function.

Conditions that require shoulder replacement surgery vary. They may result from different types of shoulder arthritis such as degenerative osteoarthritis, rheumatoid arthritis or inflammatory arthritis. They may also be the right procedure for damage caused by severe impact or wear and tear.

In severe and advanced cases, conservative treatments are often not enough and a shoulder replacement becomes imperative.

Other conditions that may require shoulder replacement surgery are:

• Major fractures
• Injuries to the upper arm (humerus and glenoid fracture)
• Osteoarthritis
• Rheumatoid arthritis and other inflammatory disorders.
• Instability (chronic shoulder dislocation)
• Some types of shoulder conditions can affect blood flow to the humerus. When a bone is starved of blood, the joint surface can collapse.
• Rotator cuff injuries. The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Rotator cuff injuries sometimes can result in damage to cartilage and bone in the shoulder joint.

Shoulder replacement surgery is highly effective in relieving pain, improving shoulder range of motion, and enhancing the shoulder’s ability to move and perform daily activities. This procedure can significantly improve the quality of life for patients suffering from severe shoulder joint damage, enabling them to return to their favourite activities with less pain and greater mobility.

However, as with any surgical procedure, there are some risks involved. These include the potential for the new joint to become dislocated, fractures occurring during or after surgery, and the possibility of the implant loosening or wearing out over time. Additionally, there is a risk of rotator cuff failure, nerve damage, blood clots, and infections at the incision site or in deeper tissues. Despite these risks, advancements in surgical techniques and implant technology have made shoulder replacement a beneficial option for many patients. 

Before the procedure

Before Shoulder Replacement Surgery, a CT scan will be arranged and the images loaded into a special computer program, which generates a 3D virtual model of your shoulder. Dr Chua will then place the components through a virtual simulation, to find the best match for your specific anatomy.

From this plan, a 3D printed model and guide specific to your shoulder will be generated and the virtual model uploaded to the mixed reality headset. These will be used during the surgery for accurate insertion of the implants to match the planned position.

A comprehensive, preoperative medical assessment with a specialist medical physician (internal medicine specialist) will be arranged for you to ensure that the procedure is carried out as safely as possible. The same doctor will also be involved in your care while you are in hospital.

You may need to have some simple investigations including blood tests and an ECG which measures the electrical activity of your heart.

In the lead up to surgery, it may be worthwhile making some simple changes in your home to make life easier when you return from the hospital. It may be hard to reach high shelving or cupboards so go through your home and place any items you need on low shelves.

During the procedure

We will speak to you about how you’ll be sedated for surgery before the procedure starts. Most people are administered general anesthesia and a nerve block. General anesthesia puts you into a deep sleep and the nerve block numbs your shoulder so that pain control can continue after you wake up from general anesthesia.

After the procedure

After surgery, patients typically stay in the hospital for only one to two days, where discomfort is managed with effective pain medication and antibiotics are administered to prevent infection. For the first few weeks, your arm will be supported by a sling, but you will be able to use the arm for simple tasks like eating, drinking and having a shower. Driving is generally not recommended during this period. Rehabilitation begins the day after surgery, with a gradual program aimed at regaining strength and movement in your shoulder, elbow, wrist and hand. Regular follow-up appointments ensure you receive attentive care, including wound care and thorough evaluations to monitor your recovery progress.

• How long does it take to recover from shoulder replacement surgery?
  The recovery period varies from person to person and also depends on the extent of damage and the type of surgery performed. It is important to discuss your goals with Mr Soong Chua and your physiotherapist so that your rehabilitation program can be planned accordingly.

• How painful is a shoulder replacement?
  You will not feel pain during the surgery because of the effect of the anesthetics however, it is part of the natural healing process to feel some pain post-surgery. You may be prescribed some medication such as opioids and Nonsteroidal anti-inflammatory drugs (NSAIDS) to relieve the pain.After Shoulder Replacement Surgery, most people feel less pain than they did before surgery, however it is important to note that an artificial shoulder never feels the same as a normal shoulder and it is important to take care of it long term.

• What should you avoid after a shoulder replacement?
  With modern replacements and techniques, most shoulder replacements are very stable and you can start to use the arm straight away for day to day, light tasks. Driving should be avoided for the first 4 to 6 weeks. As the shoulder recovers, avoiding heavy activities and sudden forceful movements will help to ensure your shoulder replacement lasts for as long as possible.