Saturday, June 6, 2015

Shoulder joint replacement for arthritis - when is the right time to have surgery? FAQ

We received this message on FaceBook today:

"Thank you for your blog,and the information you post here on Facebook.

I am 52 and can't play catch or shoot a basketball with my 14 year old son. I have to support my arm with my other arm in order to lift it over my head, or grab something from the back of the refrigerator.

I have bone on bone Arthritis, 1/2 inch bone spurs, and loose debris in my shoulder.

That being said, my Dr. has recommended Ream and Run for me. I like that it is not restrictive.

My fear is that although I can't through a ball or lift my arm over my head, I am still able to work good down low. I just baled and stacked 56'000 pounds of hay this week by hand. I need to be able to work and work hard.

I am worried about the what ifs... The information you have provided is great, and I am getting more jazzed about the surgery. But not totally sure yet if it is right thing to do.

If I wait to do the surgery, is there a chance of damaging my shoulder to the point, that I may not have the option to do ream and run?

Thanks again for your time,


The answer is that there is never a perfect time to have an elective surgery, such as a shoulder joint replacement for arthritis. The surgery and recovery from it will interfere with work and activities of daily living for a substantial period of time. The time necessary for recovery will be determined by the severity of the arthritis, the excellence of the surgery, the commitment of the patient to the rehabilitation effort, and the activities the patient desires to resume after the surgery. See this post.

The other factor is that arthritis is a progressive process - it can lead to progressive bone loss that makes the surgery and recovery from it more difficult. See for example this post on the Bad Arthritic Triad. It is easy to see that once put in motion, the process of posterior glenoid destruction is likely to continue.

So what advice can be offered to K, who can work but can't play with his son and who needs to be able to 'work and work hard'. 

The most important thing is to assure that the shoulder and the patient are assessed by someone experienced with the ream and run. This assessment needs to include the condition of the shoulder by standardized x-rays as well as the needs of the patient with respect to work and the ability to take time off to dedicate to post surgical rehabilitation. If it is not clear that 'now' is the time for surgery,  we will often re-evaluate the shoulder at 6 month intervals to determine the rate of progression of the arthritis. During this period of monitoring we will suggest gentle range of motion exercises to preserve the flexibility of the joint along with activity modifications that might lessen the impact of the arthritis.

The choice to proceed with surgery needs to be one shared between the surgeon and the patient.  And, as we say, "the decision is often more difficult than the incision" . 

Be sure to click on this link to the Shoulder Arthritis Book.
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