In early August 2017, a stemless implant shoulder replacement surgery was performed at the Global Hospitals for the first time in India. The patient was advised shoulder arthroplasty, or shoulder surgery as she was suffering from chronic pain in her left shoulder, which was diagnosed as shoulder arthritis. Orthopedic doctors recommend arthroplasty when a patient is unable to perform daily tasks or lift the arthritic arm. The shoulder replacement surgeons then removed the arthritic joint and replaced it with a metal ball and a plastic socket. In short, the surgeons created an artificial shoulder joint. Post-surgery, the patient was not prescribed any medicines to reduce pain. Instead, the patient only had to undergo few sessions of physiotherapy to ensure smooth shoulder movement.
Shoulder joint replacement surgery was first performed in the 1950s in the United States of America to treat severe shoulder fractures. It is usually opted when medications and physiotherapy fail. Later, it came to be used for relieving different forms of arthritis. Shoulder joint replacement surgery is required in patients with conditions of:
Rotator Cuff Arthropathy
Avascular Necrosis (Osteonecrosis) or
Currently, some of the common shoulder surgeries performed are :
Arthroscopy for Impingement Syndrome
Arthroscopic SLAP Repair
Arthroscopy for Shoulder Dislocation
Arthroscopy for Frozen Shoulder
Rotator Cuff Repairs
Acromioclavicular (AC) Joint Repairs
Biceps Tendon Surgery
Types of Shoulder Surgeries
Total Shoulder Arthroplasty (TSA) or Total Shoulder Replacement
Total Shoulder Arthroplasty (TSA) or Total Shoulder Replacement surgery is one of the conventional shoulder joint surgeries. It is performed on patients with acute shoulder joint pain or stiffness resulting from arthritis or any other degenerative joint disease of the shoulder. In this procedure, the glenoid (socket) and the humeral head (ball) are replaced with a metal ball and a plastic socket. An artificial humeral stem is fitted into the humerus (upper arm bone) to hold the ball. A TSA can be performed only when the muscles and tendons around the shoulder joint are intact. This means, only if the Rotator Cuff is in good health, can a TSA be performed.
Reverse Total Shoulder Arthroplasty (RTSA)
However, in cases where the damage to the rotator cuff is irreparable, or the patient has suffered complex fractures or if a TSA has failed to rectify the problem, a Reverse or Inverse Total Shoulder Arthroplasty (RTSA) is suggested. In this procedure, the ball is constrained in a cup inserted into the end of the humerus and the metal ball is attached to the shoulder bone. This enables the patient to use the healthier, deltoid muscle instead of the torn rotator cuff. An RTSA can be successful only if the patient is not a diabetic, is not on an immunosuppressant or is not having rheumatoid arthritis. So also, the bones of the patient should be healthy for an RTSA to be successful.
Rotator Cuff Repair
The Rotator Cuff is a group of muscles originating from the shoulder blade with its tendons forming a cuff which covers and is attached to the upper arm bone. Its normal functioning ensures smooth movement of the shoulder joint. Being a mass of muscles, the Rotator Cuff may get torn or detached. It is unable to heal on its own and in such cases a surgery is recommended. After the diagnosis of cuff disease by radiology testing, an open surgical cuff repair surgery or a mini-open rotator repair surgery is recommended. In the former, the torn tendons are directly repaired by making a large incision. In the latter, only an arthroscopic portion of the surgery is involved. A small incision is made to access the torn Rotator Cuff tendon. Using an arthroscope, the surgeon can look into the shoulder joint to clean of any damaged tissue or bone spurs. On completion of the arthroscopic portion, the tendon is repaired back to the bone.
A more recent development in this area is the All-Arthroscopic Rotator Cuff Repair, where the surgeon makes incisions and repairs the worn tendons by looking through a camera and its repairs on a TV monitor.
Shoulder arthroscopic surgery has been performed since the 1970s. An arthroscopic shoulder surgery is less painful and the patient recovers faster too. Each year, improvements take place to shoulder arthroscopy as new instruments and techniques are developed.
Shoulder reconstruction is a surgical procedure performed on patients reporting shoulder instability. Shoulder instability occurs when the shoulder joint becomes loose. This happens when the structures that surround the shoulder joint such as ligaments, cartilage and capsule get overstretched or injured. A loose shoulder joint then causes its dislocation. In a shoulder reconstruction surgery, the torn area is stitched back to the shoulder socket using special anchors and the overstretched capsules and ligaments are tightened. A shoulder reconstruction can be performed through a scope, also called a key hole surgery while an open surgery may be needed in some cases.
Treatment in India
India makes for an attractive destination for medical tourism given the expertise of skilled doctors and the availability of latest equipments. Unilateral Total Shoulder Replacement in India costs approximately between USD $6,500-$7,000. Arthroscopic repair in case of cuff rotator repair costs approximately USD $5,000. Arthroscopic surgery for frozen shoulder costs approximately USD $4,000.
From among a plethora of options to undergo shoulder joint surgery in India, here is a list of some hospitals that offer excellent treatment for rare and complex orthopaedic problems.
Fortis Hospital, Uttar Pradesh
Rockland Hospital, New Delhi
Extreme Orthopedics, Telangana
Trauma & Orthopedic Speciality Hospital, Tamil Nadu
Shoulder India, Tamil Nadu
Apollo Spectra Hospital, New Delhi and Karnataka
Kokilaben Dhirubhai Ambani Hospital, Mumbai
Desun Hospital, West Bengal