Total Shoulder Arthroplasty: What You Need to Know About TSA Surgery

Posted in Uncategorized on: February 15th, 2019 by sdadmin No Comments

Total shoulder arthroplasty is a surgery intended to restore function and comfort to an arthritic shoulder. We take a look at what it involves.

Total shoulder arthroplasty

Hands up if you know what total shoulder arthroplasty involves?

If your hand is down, it may mean you don’t know. In which case, you’re not alone. Unless you’ve looked into the procedure, you probably haven’t heard of it.

Or it may mean that you simply can’t raise your arm due to an injured shoulder. In which case, you may be a candidate for TSA surgery.

Total shoulder arthroplasty is a surgery intended to restore function and comfort to an arthritic shoulder. We take a look at what it involves.

What is Total Shoulder Arthroplasty?

First things first. It’s important to understand as much as possible about this procedure, especially if you’re thinking about having it yourself. Keep reading to find out all you need to know.

Total shoulder replacement or total shoulder arthroplasty (TSA) is a procedure that replaces the ball and socket joint with a prosthesis. Diseased and damaged shoulders require a prosthesis since the joint has been worn down. The prosthesis is made of metal and polyethylene components.

A reverse total shoulder arthroplasty, or rTSA, refers to a similar procedure. In a rTSA, the prosthetic ball and socket that make up the joint are reversed to treat specific complex shoulder problems.

When we talk about the “ball” and “socket”, we’re referring to the head of the humerus and the depression of the scapula or the ‘glenoid’.

Is it Successful?

Total shoulder arthroplasty is an extremely successful procedure for treating stiffness and severe pain.

The serious discomfort experienced by the person requiring surgery is often a result of the end stage of various forms of arthritis or degenerative shoulder disease.

The main goal of shoulder replacement surgery is pain relief. The secondary benefit is restoring motion. If motion is restored, the person will also regain the function and strength of their shoulder. Ideally, the patient will return to an activity level as near to their normal as possible.

The good news is that most TSA patients return to their sports after surgery. Tennis players, golfers, and swimmers are all able to return to training after surgery. At the same time, they’ve been able to continue their strength training, yoga or pilates too.

TSA Surgery Background

The first recorded shoulder arthroplasty happened in 1894 by French surgeon, Jean Pean. The original implant was made of a platinum and rubber implant for the glenohumeral joint.

Charles Neer developed the modern TSA in the 1950s. Neer began developing more advanced prostheses, closer to the ones we know today, for surgical procedures.

Every year there are around 23,000 shoulder replacement surgeries. In contrast, a whopping 343,000 hip replacements and the 400,000 knee replacements happen annually. This discrepancy is largely due to the relative complexity of the shoulder joint.

The complexity of the shoulder region means there are multiple variations in surgical procedures and prostheses. Depending on the tissues implicated, the treatment varies widely from case to case.

Since Neer’s first design in 1951, more than 70 different shoulder systems have been designed for TSA shoulder surgery.

Where are we Now?

We have come leaps and bounds from the earliest shoulder replacement surgeries. Once upon a time, they could only treat proximal humeral fractures.

But these days, current implications for shoulder arthroplasty include posttraumatic arthritis, primary osteoarthritis, inflammatory arthritis, osteonecrosis of the humeral head and neck, and pseudoparesis caused by rotator cuff deficiency.

It’s, therefore, critical that all healthcare practitioners understand the various prosthetic options and indications for each impairment.

In line with this, algorithms exist to assure each patient is matched with the correct procedure. As the prosthetic options vary, they must also be fitted with the appropriate option.

Who Needs TSA Shoulder Surgery?

Diagnosing candidates for shoulder replacement surgery requires careful consideration.

The most common indication for TSA is shoulder pain due to arthritis. This pain isn’t controlled with non-operative treatment. Rest and anti-inflammatory medications and injections are examples of primary care treatment options.

If the pain continues and worsens with progressive stiffness and loss of motion, healthcare practitioners need to pay close attention. The patient will often experience a grinding or grating sensation within the shoulder joint.

The sensation is described by people as painful and disturbing enough to cause daily discomfort.

These uncomfortable sensations represent the bones of the ball and socket, rubbing against one another because the cartilage has totally worn away.

Standard X-rays must occur to determine the condition of the shoulder joint. In addition, a CT scan and Magnetic Resonance Imagining (MRI) may also be necessary to evaluate bone quality.

These scans will show the condition of critical surrounding structures such as the rotator cuff tendon.

The Procedure

In a TSA, the surgeon begins by separating the deltoid and pectoral muscles. This allows the surgeon to access the shoulder in a largely nerve-free area to minimize nerve damage.

Next, the rotator cuff must be opened by cutting one of the front rotator cuff muscles. The rotator cuff covers the shoulder and this opens it up. The surgeon can now view and manipulate the arthritic parts of the shoulder ball and socket.

When the arthritic sections have been removed, the surgeon inserts the implant socket and ball components. The surgeon then closes and stitches the rotator cuff muscle and cleans the incision. A bandage is then applied as a temporary covering.

During the operation, the patient will be sedated and unconscious, positioned in a sitting up position.

Recovery & Rehabilitation

In most cases, patients will wake up from surgery with some pain related to the actual surgery. Importantly, it’s not the same type of pain they’ve experienced due to their arthritis.

The amazing news is that arthritic pain is largely absent from that point forward.

Physical therapy can then begin on the first postoperative day. Following X-rays to determine that the implant is properly positioned, physical therapy is safe and effective.

During the early rehabilitation phase, sling immobilization allows the tendons which have been repaired to rest and heal.

Unrestricted, active use of the arm may begin as early as eight weeks after surgery.

It’s important for patients to seek support and guidance during this rehabilitation phase and throughout the process of total shoulder arthroplasty. Please contact us for more information.


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