Do we know Shoulder Replacement Works?

by Chris Centeno, MD /

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Shoulder replacement surgery alternative

Shoulder replacement is a tough surgery sometimes recommended when the shoulder is chronically painful due to severe arthritis. I remember back in residency learning that patients with shoulder replacement had a much more protracted recovery and were often left with continued pain despite the invasive surgery. The reason given then is still the same, the shoulder is a complex joint with many directions of movement, so unlike replacing a hip with a deep ball and socket joint, replacing a shoulder is different. The shoulder socket is shallow, so keeping the ball of the shoulder in it’s socket is largely accomplished by muscles. The trauma from the invasive surgical implant of the new joint and the long-term recovery time from shoulder replacement surgery often causes these stabilizing muscles to atrophy, leaving the remaining joint weak. You might think that with all of the big resources poured into shoulder replacement joints we would have good research showing that replacing the shoulder is better than not replacing the shoulder. However, no such data exists according to a recent study looking at research in this area. This review of many published studies concluded that we really didn’t know if shoulder replacement was better than leaving the shoulder alone and recommended more research. More recently, “resurfacing” or a “Birmingham” shoulder replacement has been all the rage, but these minimal shoulder replacements have problems related to their metal content. These smaller prostheses such as the metal on metal (MOM) type have well documented safety issues. In fact, these MOM joints were the target of several negative studies at the recent AAOS meeting where researchers demonstrated severe adverse health effects in some patients from wear particles released by the metal. If replacing the joint isn’t a good option, what else might work to help treat the pain of shoulder osteoarthritis? A small pilot study shows that two injections of hyaluronic acid (aka HA or artificial lubricants like SynVisc, OrthoVisc, Supartz, Hyalgan, etc…) helped most patients get by with less pain and increased function. Injecting steroid medications into peripheral joints like the shoulder can help short-term, but these injections don’t offer as much prolonged relief as HA injections. This longer term effect of HA injections was also echoed by a larger study that compared HA to steroids for hand arthritis. There are also other reasons to be wary of steroid injections in joints, as the combination of anesthetic and steroid commonly used by many physicians can kill off remaining cartilage cells. We’ve also seen good results with the injection of the patient’s own stem cells to treat shoulder arthritis. This procedure may be regenerative in that it may help the cartilage in the joint. The upshot? Until we have better data, you may want to stay away from invasive shoulder replacement surgery and consider looking at non-surgical options like hyaluronic acid injections or cell based therapy.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
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Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
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Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
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Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

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