In its most basic form, a shoulder replacement involves replacing the worn-down arthritic joint with metal and plastic (polyethylene). The surgical term is referred to as arthroplasty, which is synonymous with joint replacement. The joint needs to be replaced when the arthritis builds in the shoulder, which may be experienced by the patient as pain, loss of function, weakness or limited range of motion.
What is shoulder replacement surgery?
A shoulder replacement exchanges the worn-out bone and cartilage (arthritis) with metal and plastic components, which improves overall shoulder function and range of motion and provides the patient with a pain-free shoulder.
Types of shoulder replacement surgery
Patients are recommended different types of shoulder replacements depending on the status and quality of the surrounding shoulder rotator cuff muscles and the location of arthritis. Magnetic resonance imaging (MRI) is used to assess the quality of the muscles and tendon tears, and X-ray shows arthritic changes of the shoulder.
The most common shoulder replacement surgeries are anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty. The latter is recommended when the rotator cuff is torn in addition to the shoulder joint arthritis.
In some cases, hemiarthroplasty may be performed where only the humeral side of the shoulder is replaced with metal. This is done in cases with arthritis only on the humeral side and in young, active patients.
When do you need shoulder replacement?
Many patients have a long history of shoulder pain typically without any injuries to the shoulder. For patients having persistent symptoms due to shoulder arthritis, including pain or weakness despite conservative management (physical therapy and corticosteroid injections), shoulder replacement surgery offers patients a way to increase their quality of life.
Signs that a shoulder surgery may be a beneficial option may include:
Shoulder pain that severely limits quality of life
Limited range of motion and pain due to arthritis
Continued symptoms despite physical therapy and corticosteroid injections
Shoulder or arm weakness and pain due to rotator cuff tear and arthritis
Shoulder replacement surgery benefits
Some of the benefits of shoulder replacement surgery may include:
Increase the range of motion of the shoulder and arm without pain
Alleviate pain (Shoulder surgery typically has a yearlong recovery process, but most patients report improved pain management following the surgery.)
Improved activities of daily living without pain
Improved overall function of the shoulder or arm
Shoulder replacement surgery risks
Some of the potential shoulder replacement surgery risks may include the following.
Orthopedic surgery has a risk for infection, bleeding, fracture of the bone, blood clots or damage to the surrounding nerves/blood vessels/tissues. Sterile technique and care are used throughout the procedure to diminish these risks.
Components of the shoulder replacement may require revision in the future due to loosening or infection.
In reverse total shoulder replacement, dislocation may occur due to injury most often caused by falling or trauma on the shoulder.
How to prepare for shoulder replacement surgery
Physical activity is recommended as tolerated. Pain tends to limit the ability to overexert oneself, so patients are unlikely to cause additional damage to the shoulder prior to surgery. Stiffness prior to surgery is a challenge that may limit the overall improvement of range of motion that the patient will have following shoulder surgery. Physical therapy that involves strengthening and stretching the shoulder in addition to home exercises are crucial for overall success following the surgery.
As an orthopedic surgeon at Boston Medical Center, I find that typically, it takes one year of recovery for patients to feel normal again with their new shoulder replacement.
Shoulder replacement surgery: What to expect
During the surgery, patients are sedated and intubated with general anesthesia throughout the procedure. Most cases involve an 8- to 10-centimeter incision to access the shoulder joint from the front. Hardware components are sized and selected to match the patient’s anatomy. The operation in total takes between 1-2 hours, after which the patient stays overnight in the hospital before being discharged home with pain medication. Both the physical and occupational therapist will visit you in the hospital to show you how to move and do your activities of daily living after shoulder replacement.
Shoulder replacement recovery
After surgery, the shoulder is put in a sling for 4-6 weeks. Patients may come out of the sling for bathing and pendulums, which involve dangling the arm freely and moving it in a circle to avoid shoulder and elbow stiffness.
Physical therapy is started two weeks after surgery with passive ranging of the arm by your physical therapist before advancing to assisted active and full active motion. Strengthening starts about 2-3 months after surgery. People have variable progression, but it takes one year for full recovery from shoulder replacement surgery.
After shoulder replacement surgery, patients should not lift more than 10-20 pounds of weight. Golf, swimming and other low-impact sporting activities are encouraged after full recovery.
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