Aging shoulders are increasingly vulnerable to damage in the rotator cuff, the muscles and tendons that help the shoulder joint move properly. And over time, a torn rotator cuff can lead to arthritis and the prospect of major joint surgery. Canadian surgeons are working with a new type of implant that could make that option a less daunting one.
The combination of a torn rotator cuff and shoulder arthritis is called rotator cuff arthropathy. For severe cases, surgeons may recommend replacing the humeral head — the “ball” of the shoulder’s ball-and-socket joint — with a metal implant, or they may opt for a “reverse” shoulder replacement, in which a metal ball and plastic socket are implanted in the reverse of the usual positions. The latter option is recommended for people who can no longer raise their arm properly.
Dr. Darren Drosdowech, a shoulder surgeon with the Hand and Upper Limb Centre at St. Joseph’s Health Care in London, Ont., is exploring a new alternative to humeral head replacement for people with rotator cuff arthropathy who can still raise their arm. This new option is called humeral head resurfacing. “For (surgeons) who do a fair amount of shoulder surgery, they would find this a welcome relief,” he says.
The reason is that the traditional humeral head replacement involves the complete removal of the worn-out humeral head, and the insertion of a metal stem inside the upper arm bone. This hardware could be difficult to remove if it ever needed to be replaced. However, humeral head resurfacing simply involves the placement of a metal cap on the humeral head.
Drosdowech says the procedure takes an hour to 90 minutes in total, with the actual sizing and placement of the metal cap requiring only about 20 minutes. In contrast, a humeral head replacement takes about one-third longer.
He recently reported results of humeral head resurfacing in 10 people, average age 75 years, and found that over an average of 20 months the improvements in shoulder function were at least equivalent to those following humeral head replacement. One patient went on to have a reverse shoulder replacement after losing the ability to lift the arm.