While shoulder replacements provide generally good pain relief and return of function in the right people, they are not without some downside. One of the potential risks is late glenoid (socket) failure. Studies show that about 9/10 of shoulder replacements last at least 10 years. Of the ones that eventually fail however, a disproportionate number fail on the socket side.
A standard glenoid replacement is made of plastic and is cemented into the socket.
Surgeons have experimented with different designs including metal backed components with varying degrees of success. And new designs continue to come on the market in an attempt to improve on the conventional glenoid. But no design has yet proven truly optimal. Fully optimal would mean that it lasts a lifetime in everyone.
The bottom line is that we surgeons understand it is a weak link, we know that we need to be meticulous in our technique when implanting this component and we need to be on the lookout for better alternatives in the future.
BUT (and this is a big but), proving that you have developed a better implant than the conventional design is extraordinarily difficult. Long-term outcome studies take years, require independent verification and may be fraught with designer bias. Additionally the improvement must be large enough to notice upon comparison. Not always easy.
What does this all mean to you if you are contemplating total shoulder replacement?
A few things:
- Ask whether it is necessary in your specific case to implant a socket at all. In some cases it is not
- Find out what happens if your socket fails? Is revision surgery possible? Why or why not? In general, revisions are less predictable than primary cases simply due to the amount of scar tissue involved and status of the rotator cuff
- Find out what the downsides are if your surgeon is using a newer implant. What happens if it fails? Will a revision be possible?
Total shoulder replacement is still the gold standard for treating end stage arthritis in patients who have failed conservative treatments. It does however, have some limitations that may affect the eventual longevity of the result over time. And you should be aware of them.
Dr. DiPaola is one of a small percentage of orthopedic surgeons in the country that performs shoulder replacement regularly. He performs dozens each year and is skilled at performing shoulder replacement for a variety of conditions including complex and revision cases. If you are considering shoulder replacement please contact us for more information or a personal consultation.