Since metals in orthopedic surgeries now hits close to home for me (in the titanium screws in my left elbow, to be precise), I read with interest a piece in the Wall Street Journal earlier this week about the rising popularity of shoulder replacement surgeries. Those with intense arthritis in the shoulder turn to these surgeries to alleviate pain and increase range of motion. These shoulder replacements don’t last forever, with five percent of patients needing an additional surgery within a 15-year time frame, but the relief from pain makes a huge difference in quality of life for patients.
The third most frequent replacement surgery, lagging far behind hip-joint and knee-joint replacements, the number of shoulder replacement surgeries in the U.S. has significantly increased in recent years. Already boasting an annual 35,000 shoulder replacement surgeries, which doesn’t begin to compare to the 543,000 knee replacements and the 649,000 hip replacements, the Academy of Orthopaedic Surgeons anticipates a 10 percent growth in the volume of shoulder replacements, annually. “That’s partly because of the aging of the U.S. population, and because analysis has shown that shoulder surgery is less traumatic and costly than once believed,” the WSJ explains. “A study of 50,000 patients in Maryland published in 2006 in the journal Clinical Orthopaedics and Related Research found that arthritis patients undergoing total shoulder replacements had fewer complications, shorter lengths of stay, and lower total charges than those undergoing hip or knee replacements.” Good news for titanium, perhaps?
Since the shoulder essentially includes a “ball” and “socket,” most standard surgeries involve removing the ball and replacing it with an artificial, metal ball. Attached to a stem, the ball is placed in the upper arm bone, and the “socket” is replaced with a plastic version. In the “ball,” the precise metals tend to include titanium, cobalt chrome and stainless steel. One medical journal describes a ball made of cobalt chrome and a stem made of titanium. The surgery can also include a metal plate, the metaglene, attached to the scapula with screws.
However, there are two new versions of this surgery. In one version, the “reverse” shoulder replacement, the parts are placed in different areas, allowing different muscles to work the arm. Reverse replacements are for patients with the worst damage to their rotator cuffs. In the second version of the surgery, the ball is the only part of the shoulder replaced with a metal version. To complete this surgery, doctors reshape the glenoid socket with a “reamer.” “The benefit of the procedure … is that there is no plastic glenoid to possibly wear or bend, so it’s a good option for patients who are athletic or otherwise very physically active,” the WSJ explains, a statement that proves the superiority of metal to plastic.
Of course, rehab is required, since metal, unlike duct tape, can’t fix everything. But the time spent in rehab, along with the new shoulder, makes life easier and more enjoyable for patients with severe arthritis.