You are probably aware that hip fractures are the most common injuries for seniors. But, did you know that shoulder fractures and dislocations are also extremely common among this age group?
Considered the most mobile joint in the body, the shoulder can be thought of like a ball that sits on a golf tee. It consists of the round head of the humerus or upper arm bone that sits on a relatively flat socket known as the glenoid. The rotator cuff and deltoid muscle work together to rotate the ball for mobility and keep it in place. Any damage to the ball or the rotator cuff, in particular, can result in decreased, even zero, mobility and severe pain.
As an orthopedic surgeon, I see patients of all ages, but a growing number are those patients over 60 who have suddenly injured their shoulders (acutely) through dislocation or by fracturing the humerus. I also see many older patients who may have suffered an injury years ago, received treatment, and are now experiencing the long-term degradation of the joint as a result of arthritis or degeneration of the rotator cuff. How these injuries and conditions are treated can have a significant impact on a patient’s quality of life.
Non-Surgical Options First
For the most part, orthopedic injuries can be treated with pain relievers (NSAIDs), injections and physical therapy, but surgery is sometimes needed. Many of my patients come to me having spent months or even years exhausting these other options before the pain becomes too much or mobility has been too significantly compromised. That’s when surgery becomes a realistic option.
Traditional Shoulder Replacement Surgery for Fractures
For complex fractures of the shoulder, the gold standard has always been a shoulder replacement procedure called a ‘hemi’ or hemiarthroplasty. It involves recreating the shoulder joint by replacing the head of the humerus with a metal ball. The fractured bones around the joint, which are attached to the rotator cuff, must also be repositioned and secured as part of the surgery. And that is where we see many of the limitations with this type of procedure. Often, the bones don’t heal correctly, or if the placement of the joint is even slightly off, patients may experience even more pain and even less mobility after surgery.
Even done correctly, the lifespan of a hemi is limited. Considering how much longer we are living, I see many patients who have had this traditional shoulder replacement surgery become candidates for a revision or a second surgery within about 10 years.
Traditional Shoulder Replacement for Arthritis
For arthritis of the shoulder, the gold standard is a total shoulder replacement that combines the hemiarthroplasty replacement of the humeral head with the addition of a plastic socket, to restore the “golf tee”. This procedure requires that the rotator cuff is intact and working well prior to surgery. The success rate of this surgery is very high but it is not performed in patients who have a compromised rotator cuff, which is common in the elderly population.
Shoulder Surgery In The Reverse
But there is good news. At Advocate Lutheran General Hospital, we offer a relatively new procedure that is even more effective than traditional shoulder replacement for patients with fractures and compromised rotator cuffs. Recovery is much faster and mobility is usually restored right away. Called a reverse total shoulder replacement, this surgery involves the same equipment, except that the placement of those components is reversed.
In a reverse total shoulder replacement, the plastic cup is affixed to the humerus and the ball is affixed to the socket. Not only does it eliminate the need to rebuild bones, the reverse configuration puts less stress on rotator cuff and, instead, relies on the deltoid muscle for mobility. As a result, this is an ideal surgery for patients with rotator cuff tears, significant fractures and arthritis.
Approximately 20,000-30,000 total shoulder replacements are performed in the US each year, including both traditional and reverse replacements, with excellent patient satisfaction, improved function and decreased pain for more than 10 years. Having been fellowship trained in this surgery, I perform a significant number of reverse total shoulder replacements and have found them to be highly effective in restoring mobility, especially in the senior population.
So before you pick up a tennis racket, golf club, or even go to put a can of soup in the cupboard, pay a little homage to the shoulder, one of the most complex and necessary joints in the body.
To reach me with questions and for additional information, please call my office at 847-375-3000.
Ari Youderian, MD, is in Orthopedic Surgery at Advocate Lutheran General Hospital in Park Ridge.