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U.S. News and World Report: America's Best Hospitals, Kidney Disorders, Orthopedics, 2012-13

Elbow and Shoulder Joint Replacement

Contact Information
 
(608) 263-7540
 
3-D Animation Player
 
Learn about total shoulder replacement in 3-D through this interactive tool:
 
Image of the shoulder joint
UW Health orthopedics and rehabilitation doctor inspecting patient's arm, which is in a braceLocated at a complex intersection of nerves, muscles, blood vessels and tendons, the elbow can be a very intimidating area for surgeons. Since few doctors specialize in elbow surgery, patients with severe joint pain or serious fractures are often left without a specialized treatment option.
 
UW Health's department of Orthopedics and Rehabilitation offers the services of an orthopedic surgeon who specializes in both total shoulder and total elbow replacement surgery.
 
Many physicians aren't aware that elbow replacement is an option, so as a result, patients may unnecessarily sufer from painful, stiff elbows.
 
Elbow and shoulder replacements are less common than hip and knee replacements because there is normally less wear and tear on those joints, and patients often tolerate elbow and shoulder arthritis better than hip and knee conditions. For those who don't, surgery can offer relief.
 
The primary reason for doing a total elbow or shoulder replacement is pain - such as that experienced by patients with serious degenerative or rheumatoid arthritis. Another subset of candidates for the procedures includes patients with unreconstructable joint fractures.
 
Total shoulder and total elbow replacement are more common in older patients, because the prostheses tend to have a finite life expectancy - usually around 15 years - and because the condition of younger patients suffering from joint problems can often be improved without surgery.
 
Advances in Equipment, Technique
 
The modern elbow prosthetic has been in use since the early 1980s, and is semi-constrained, allowing for early motion with greatly enhanced stability. Shoulder prosthetics, meanwhile, have entered a modular era, using an eccentric head that allows surgeons to better match a patient's individualized anatomy.
 
Instrumentation has also improved. In the past, surgeons would make saw cuts basically freehand or with a small template. Now, the cutting guide is attached directly to the bone, so there's more control over where the surgeon makes incisions.
 
The condition of the rotator cuff is still the prime factor in determining whether a patient is a candidate for total versus partial shoulder replacement.
 
Older patients with severe elbow fractures can, at times, do well without surgery, but that's not the case with displaced shoulder fractures. In significantly displaced shoulder fractures in older patients, acute replacement often provides a better, more functional outcome. If the fragments of bone attached to the rotator cuff are significantly displaced and nothing is done, the muscle will ultimately atrophy and make delayed surgery significantly less successful.
 
Patients who undergo elbow and shoulder replacement can expect to return to normal, pain-free daily activity, but not to resume sports like tennis, golf or bowling, which can wear out the shoulder.