"Today" show co-host and weatherman announced last week that he was about to undergo a total right shoulder replacement. Roker, 65, says that osteoarthritis pain that has not responded to less invasive treatment :
"It's not bad during the day, but at night it's an intense pain that literally wakes me up," Roker said on the show. "For the last month, I've only been sleeping about two or three hours a night, which even for me is a little bit less."
This is not Roker's first surgery for arthritis-related pain. He had a knee replaced in 2001, followed by his other knee in 2016. In 2014, he underwent a rotator cuff repair on his left shoulder. In September 2019, he had his left hip replaced. Al joked: "The deal is that I'm going to have replaced everything by 2027." (He also underwent .)
Riley Williams, III, MD, is the orthopedist who performed Roker's first shoulder surgery and will oversee his current procedure at the Hospital for Special Surgery in New York City. Williams on that Roker's treatment is "really designed to just basically restore the normal joint services so that the arthritic, achy pain that he's been having and waking him up at night can go away and we can kind of get him back on a road to recovery."
The day after his Today show appearance, Al underwent his procedure. One day post-op, his "Today" show family: "Well, I am not gonna lie.... This one, this surgery, as opposed to hip, knees, rotator cuff -- this one was tough." He went on to say: "So, I had my first PT session and I got ahead of myself now with my medication. I kind of let that slip. Once the nerve block wore off, I was in a lot of pain, so I learned my lesson. Stay ahead with my meds and have my PT session and ... hopefully [I'll be] discharged [today]."
A Brief Review of Shoulder Anatomy
The shoulder is structurally and functionally complex. This complexity allows it to be one of the most freely moveable areas of the body. It allows the arm to move forward and backward, rotate in a circular motion, and hinge out and up away from the body. The shoulder is made up of three bones: the humerus (upper arm bone), clavicle (collar bone), and scapula (shoulder blade), and two joints: the acromioclavicular joint and the glenohumeral joint.
The glenohumeral joint is where the ball shaped head of the humerus fits into a cuplike socket part of the scapula called the glenoid. The acromioclavicular joint connects a finger-like extension of the scapula called the acromion and the clavicle.
The rotator cuff connects the humerus to the scapula. It is made up of the tendons of four muscles, the supraspinatus, infraspinatus, teres minor, and the subscapularis. Tendons attach these muscles to the bones. Although the socket/glenoid is relatively shallow and flat, the muscles of the rotator cuff keep the humerus tightly in the socket. The rotator cuff is rimmed with soft tissue, called the labrum, which makes a deeper socket for the humeral head. A joint capsule, made up of ligaments, surrounds the shoulder joint and is filled with synovial fluid that lubricates the joint.
Shoulder Joint Replacement
According to the (AAOS), shoulder replacement surgery was first used in the U.S. in the 1950s. It was primarily used to treat severe shoulder fractures. Since that time, its use has been expanded to treat severe joint pain and decreased mobility.
Currently, approximately 53,000 people in the U.S. have shoulder replacement surgery each year. This should be compared with over a million knee and hip replacements/year. In 2018, the AAOS that by 2030, primary THR (hip) is projected to grow 171% and primary TKR (knee) is projected to grow by up to 189%, for a projected 635,000 and 1.28 million procedures, respectively. By 2060, primary THR is expected to reach 1.23 million (330% increase), primary TKR is expected to reach 2.60 million (382% increase).
Conditions That Can Lead to Shoulder Replacement
- Osteoarthritis occurs when the cartilage in the joint wears down over time and the bones rub together. The joint slowly becomes stiff and painful. It typically occurs in people 50 years of age or older. This is a common reason for shoulder replacement surgery.
- In rheumatoid arthritis the immune system causes inflammation, making the synovial membrane around the joint inflamed and thickened. Chronic inflammation damages the cartilage leading to pain and stiffness.
- Post-traumatic arthritis following a serious shoulder injury.
- Rotator cuff tear arthropathy can occur with a large, long-standing rotator cuff tear.
- Avascular necrosis occurs when the blood supply to the bone is disrupted. This can lead to destruction of the shoulder joint. Risk factors include chronic steroid use, deep-sea diving, sickle cell disease, and heavy alcohol use.
Types of Shoulder Replacement Surgery
Total Shoulder Replacement
In this procedure, the head of the humerus is removed and replaced with a polished metal ball attached to a stem. The joint surface of the glenoid is replaced by a plastic socket. The replacement components can be cemented or glued into place or can be "press fit." Press fit is a cement/glue-free procedure. It is used in patients who have sufficient healthy bone. The implants are made with porous metal which is pushed in against the bone. The porousness of the material allows the bone to grow into the implants. Although healing time may be longer, it has a potential for a more permanent fixation. This makes it especially appealing for younger patients undergoing joint replacement.
Reverse Total Shoulder Replacement
In a reverse total shoulder replacement, the positions of the ball and socket are switched, i.e. the metal ball is implanted where the socket was, and the socket is placed on the head of the humerus.
The reverse design is believed to have more stability because it does not depend on tendons to hold it in place. It is used in situations where there is a torn rotator cuff with arm weakness or severe arthritis, or in patients that had a failed previous shoulder replacement.
Stemmed Hemiarthroplasty
In this procedure, only the ball is replaced with a metal ball and stem. It can be used where the glenoid is healthy with an intact cartilage surface.
Resurfacing Hemiarthroplasty
This procedure involves replacing only the head of the humerus with a cap-like prosthesis without a stem. This option may be attractive to otherwise very active or younger patients as it avoids the risk of the ball and stem becoming loose over time. It can also be easier to convert to a total shoulder replacement if necessary later.
Complications of Joint Replacement Surgery
New technology and advances in surgical techniques have greatly reduced the complications involved with joint replacements. When problems do occur, most are treatable. Possible problems include:
- Infection: Areas in the wound or around the new joint may get infected. It can happen shortly after the procedure, or even years later. Minor infections in the wound are usually treated with antibiotics. Deep infections may need a second operation to treat the infection or replace the joint. Any infection in the body can spread to a joint replacement.
- Loosening: The new joint may loosen, causing pain. If the loosening is severe, another operation to reattach the joint to the bone may be necessary.
- Dislocation: Sometimes after joint replacement, the ball of the prosthesis can come out of its socket. Revision surgery may then be necessary.
- Wear: Some wear can be found in all joint replacements. Too much wear can lead to loosening. Revision may be necessary if the prosthesis comes loose. Sometimes, if only the plastic wears thin, replacement of the plastic and not the whole joint may be possible.
- Nerve and blood vessel injury: Although infrequent, nerves near the replaced joint may be damaged during surgery. Over time, the damage often improves and may disappear.
Sources: ,
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.