Minimally Invasive Shoulder Joint Replacement
Minimally Invasive Shoulder Joint Replacement
Shoulder joint replacement is a surgical procedure that replaces damaged bone surfaces with artificial humeral and glenoid components to relieve pain and improve functional ability in the shoulder joint.
It can be performed by a traditional open approach or through a minimally invasive approach. The incision of a minimally invasive shoulder joint replacement is about 5 cm compared to 17 cm with the traditional approach.
Indications for Minimally Invasive Shoulder Joint Replacement
When conservative measures such as medications, injections, physical therapy, and activity changes do not help relieve pain from conditions such as arthritis, avascular necrosis, and humeral head fractures, then shoulder joint replacement is considered as a treatment option.
The decision to perform shoulder replacement via the traditional approach or the minimally invasive approach depends on the pathology. Exposure of the glenoid is often difficult even when the incision is long as in the traditional approach. Therefore, if the pathology is such that more exposure to the joint is required for the surgical treatment then a traditional approach is preferred.
The minimally invasive approach is generally preferred when the problem can be rectified by replacement of only the humeral head such as with the following conditions:
Shoulder arthritis with not much damage to the glenoid and with only small bone spurs
Four-part humerus fractures with intact rotator cuff
Avascular necrosis of the humerus, resulting in tiny multiple fractures
To determine the pathology, your surgeon orders an X-ray of the shoulder in the anteroposterior and axillary view. The axillary X-ray is especially important to check the condition of the glenoid. In case the condition is not very clear, your surgeon orders a CT scan of the shoulder to provide more detailed cross-sectional images of the bone and soft tissue of the shoulder including the glenoid.
Minimally Invasive Shoulder Joint Replacement Procedure
The surgery is performed under sterile conditions in the operating room under regional or general anesthesia.
You will lie in a beach chair position with the operated arm held by an arm positioner.
A 5-cm incision is made over the shoulder joint.
The muscle overlying the shoulder bones are cut just enough to expose the head of the humerus.
The humeral head is dislocated and released from the capsule.
The arthritic or damaged humeral head is cut at the neck and removed.
The humeral component is matched in diameter and thickness to the natural humeral head.
A bone tunnel is made in the humerus to take the humeral stem.
The humeral stem is then inserted into the humerus. This may be press-fit, relying on the bone to grow into it or cemented, depending on several factors such as bone quality and your surgeon’s preference.
If the glenoid also needs to be replaced, your surgeon then proceeds to the preparation of the glenoid component.
The glenoid is sized for the appropriate implant.
Next, the glenoid is prepared to take the artificial component by drilling holes in the glenoid to fix the plastic glenoid component.
Bone cement is placed in the holes and the glenoid implant is inserted.
Once the glenoid is replaced with the plastic component, your surgeon works on the humeral component.
The correct sized metallic humeral component is then fixed to the humeral stem.
The soft tissue covering the joint is sutured back together and the incision closed with absorbable sutures.
An X-ray is taken to verify the correct fit (size and position) of the implant.
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