Shoulder Surgery: Reconstruction vs Replacement

A Guide by Dr Gavin Nimon ( Adelaide Shoulder Surgeon)

The human shoulder is a marvel of biomechanics, facilitating a wide range of motions and tasks. Yet, with this complexity comes vulnerability to injuries and degenerative conditions. When non-operative treatments fail, surgical interventions like reconstruction and replacement are often considered. As an experienced Adelaide Shoulder surgeon, I often encounter patients confused between shoulder reconstruction and replacement. This blog aims to shed light on these procedures, guiding you through the decision-making process.

Shoulder Reconstruction

What is Shoulder Reconstruction?

Shoulder reconstruction typically refers to surgical procedures that restore the normal anatomy and function of the shoulder without replacing any bones. The primary aim is to preserve the shoulder’s original structure while repairing any damaged components.

Types of Shoulder Reconstructions:

1. Rotator Cuff Repair: The rotator cuff is a group of tendons and muscles that stabilize the shoulder. Tears, often due to wear and tear or injury, can lead to pain and weakness. Repair involves sewing the torn tendons back to their attachment
   
2. Labral Repair: The labrum is a cartilage ring around the shoulder socket, helping keep the head of the humerus (upper arm bone) in place. Tears in the labrum can be painful and destabilize the joint. Reconstruction involves anchoring the torn labrum back to the bone.
3. Capsular Shift: For those with joint instability, especially after dislocations, the joint capsule might stretch. This procedure tightens the joint capsule to restore stability.
4. SLAP Repair: A specific type of labral tear, SLAP tears involve the upper part of the labrum where the biceps tendon attaches. Repair is similar to standard labral repairs but focuses on this region, often this can also be addressed be releasing the biceps off the labrum and attaching it outside the shoulder joint, a biceps tenodesis.

Types of Shoulder Replacements:

1. Total Shoulder Arthroplasty (TSA): This is the most common type, replacing both the ball (humeral head) and socket (glenoid) with prosthetic components.
2. Reverse Shoulder Arthroplasty: What is Reverse Shoulder Replacement Surgery, Here, the ball and socket’s positions are swapped. This is often used in cases with severe rotator cuff damage, where the traditional method might not work effectively.
3. Partial Shoulder Replacement (Hemiarthroplasty): Only the ball (humeral head) is replaced, preserving the natural socket. This is done very rarely.

When is Replacement Preferred?

Shoulder replacement is usually considered for older patients with significant arthritis, joint degeneration, or those where reconstruction might not provide the desired results due to extensive damage,.

Shoulder Surgery Recovery Time

No matter what surgery is undertaken, most procedures require 6 weeks in a sling with physiotherapy supervised rehabilitation. Driving can commence, once safe, several weeks after the sling is ceased.

Range of motion usually recovers over another 6 weeks with the introduction of strengthening supervised by the physiotherapist. While most things can be performed after 3 months from surgery, full unrestricted duties is usually possible a total of 6 months after surgery. The shoulder however will continue to improve for a full year after surgery.

Conclusion

Choosing between shoulder reconstruction and replacement depends on various factors, including the specific shoulder condition, age, activity level, and overall health. At Glenelg Orthopaedics, Dr Gavin Nimon can guide you through the decision-making process, ensuring the best outcome for your individual situation. Glenelg Orthopaedics for Quality Orthopaedic Care.