Joint Preservation & Cartilage Repair
Partial Shoulder Replacement
What is Partial Shoulder Replacement?
Partial shoulder replacement, also called shoulder hemiarthroplasty, is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact.
Indications of Partial Shoulder Replacement
This surgical procedure is indicated in severe, persistent conditions of shoulder osteoarthritis in which only the humeral head or ball of the joint is damaged. Osteoarthritis is a degenerative condition in which the cartilage that allows smooth movement in the joints wears away causing the adjacent bones to rub against each other resulting in pain and stiffness. In such conditions, replacement of the damaged portion of the humerus will reduce the friction as bone ends can no longer come in contact with each other thus ensuring relief from pain.
Procedure of Partial Shoulder Replacement
Surgery remains as a sole treatment option when all possible conservative means of treatment such as rest, anti-inflammatory medications, physical therapy have been ineffective in resolving your symptoms. While the procedure may relieve your pain and other symptoms, there may also be associated risks and complications as with any major surgery.
Risks and Complications of Partial Shoulder Replacement
Potential risks and complications that may occur following shoulder hemiarthroplasty include infection, instability, fractures of the humerus or scapula, shoulder stiffness, damage to the blood vessels and nerves.
Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.
Cartilage restoration is a surgical procedure where orthopedic surgeons stimulate the growth of new cartilage that restores the normal function. Arthritis condition can be delayed or prevented through this procedure.
Several techniques are employed for cartilage restoration including dietary supplements, microfracture, drilling, abrasion arthroplasty, osteochondral autograft, and allograft transplantation.
- Dietary supplements: Dietary supplements such as glucosamine and chondroitin are the non-surgical treatment options for cartilage restoration. Chrondroitin sulphate and glucosamine are naturally occurring substances in the body that prevent degradation of cartilage and promote formation of new cartilage. Chrondroitin sulphate and glucosamine obtained from animal sources are available as over the counter products and are recommended for cartilage restoration. Apart from these various other nutritional supplements are also recommended such as calcium with magnesium and vitamin D as a combination, S-Adenosyl-Methionine and Methylsulfonylmethane.
- Microfracture: In this method numerous holes are created in the injured joint surface using a sharp tool. This procedure stimulates healing response by creating new blood supply. Blood supply results in growth of new cartilage.
- Drilling: In this method a drilling instrument is used to create holes in the injured joint surface. Drilling holes creates blood supply and stimulate growth of new cartilage. Although the method is similar to microfracture, it is less precise and the heat produced during drilling may damage other tissues.
- Abrasion Arthroplasty: High speed metal-like object is used to remove the damaged cartilage. This procedure is performed using an arthroscope.
- Osteochondral Autograft Transplantation: Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the injured joint place. This method is used for smaller cartilage defects.
- Osteochondral Allograft Transplantation: A cartilage tissue (graft) is taken from a donor and transplanted to the site of the injury. Allograft technique is recommended if larger part of cartilage is damaged.
- Autologous Chondrocyte implantation: In this method a piece of healthy cartilage from other site is removed using arthroscopic technique and is cultured in laboratory. Cultured cells form a larger patch which is then implanted in the damaged part by open surgery.
- Osteoarticular transfer system (OATS): Osteoarticular transfer system (OATS) is a surgical procedure to treat isolated cartilage defects which usually 10 to 20mm in size. The procedure involves transfer of cartilage plugs taken from the non-weight bearing areas of the joint and transferring into the damaged areas of the joint.