The shoulder joint is the third most common joint replaced in the body. The shoulder is a ball-and-socket joint: the ball (humeral head) of your upper arm bone (humerus) fits into a shallow socket (glenoid). When this joint becomes worn or painful, your surgeon may recommend a shoulder replacement.
Sometimes, only the “ball” is replaced, this is called a hemiarthroplasty. When the “ball and socket” are both replaced, this is called a total shoulder arthroplasty. The ball is made of metal and the socket is made of metal or plastic.
Your surgeon will perform a physical; take X-Rays or other electronic pictures to see if shoulder replacement surgery is right for you. Age is usually not a factor.
If you have pain, limited movement, cannot sleep well at night or cannot perform everyday tasks, your surgeon may recommend shoulder replacement surgery for you.
Shoulder replacement surgery is performed in the hospital by a trained orthopaedic surgeon. Commonly, the procedure takes between 1- 3 hours. An incision is made that is between 3-8 inches in length and is made in the front or side of the shoulder in order to gain access to the joint. The humeral head (ball) is removed and a metal stem is placed in the humerus (arm bone).
The stem serves as a base for the new humeral head (ball) to sit on. If you are having a total shoulder replacement, the glenoid (socket) is smoothed and prepared and a metal or plastic component is attached so that it articulates with your new humeral head (ball).
You should expect to stay in the hospital between 1-3 days; however it could depend on many factors and your surgeon will determine this.
Most patients will have no abnormalities.
You will have a visible scar on the front or side of the shoulder from the incision.
When a patient has a torn or severely weak rotator cuff muscle, your surgeon may recommend a procedure called a reverse shoulder replacement. The reverse shoulder replacement is similar to a total shoulder replacement except in a reverse shoulder replacement, the socket and metal ball are switched. The ball is fi xed to the socket and the cup is fi xed to the upper end of the humerus. The reverse shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. Your surgeon will determine which procedure is best for you.
Shoulder replacement surgery is a major operation and while uncommon, there are always risks during and after any major surgical procedure. Some complications can include, but are not limited to, blood clots, infection, implant breakage, malalignment, dislocation, stiffness, nerve damage and implant wear. To help avoid complications, your surgeon may prescribe antibiotics or blood thinners prior to and after surgery. Some patients could experience stiffness or pain after surgery. Age and activity level effect longevity of the implant. You should discuss these and other risks with your surgeon.
Resurfacing is a procedure where the patient’s humeral head is not removed; it is instead “reamed” down to fi t a metal “cap” on the top of the bone. This “cap” functions as a humeral head and can be less invasive than a total joint replacement procedure. Your surgeon will determine if you are good candidate for shoulder resurfacing.
You should discuss all medications you are currently taking with your surgeon prior to surgery. Your surgeon will advise you if you need to make any adjustments with your medication. Certain steroids can cause a delay in healing after surgery and your surgeon may recommend you not take them. Make sure your surgeon is aware of any steroids you may be taking. Generally, your surgeon will also advise you to stop taking any anti-infl ammatory medications such as aspirin, or ibuprofen fi ve days prior to your surgery. These medications cause the blood to thin and can lead to excessive bleeding during surgery. Your surgeon will discuss these and all medications you are taking prior to surgery.
Returning to work can be as soon as 2 weeks or as long as 3 months, but your specifi c timetable will depend on your job and your surgeon’s recommendation. Your surgeon will determine when you will be able to return to work based on your job responsibilities. Returning to work will also depend on your commitment to rehabilitation.
Therapy is crucial to proper rehabilitation of your shoulder. Your surgeon along with a team of therapists will work to design a rehabilitation program specifi c to you. Therapy may begin as soon as the day of surgery and, subject to your surgeon’s recommendation, can last several months post-surgery. Your commitment to following your therapy program will determine how well you recover.
It is good to have someone help you with daily activities the fi rst few days or weeks after surgery. You should be able to return to normal activities such as dressing and grooming within a few weeks.
In most cases your surgical incision will be closed with absorbable sutures and covered with surgical glue or staples. Most of the time, you will be able to shower in about 2-3 days after surgery, but you will not be allowed to submerge your incision in water. A bandage should cover the incision until the 2 week follow-up appointment with your surgeon. Your surgeon will advise you of exactly when you will be able to shower based on the type of closure performed.
While on any type of narcotic pain medication, you will not be able to drive. You will also be required to wear a sling and there are different state laws that allow you to drive or not with a sling. Your surgeon will advise you when you will be able to drive again, most likely in 4-6 weeks approximately.
You will generally be in the hospital for 1-3 days. When you leave the hospital, you will be in a shoulder sling and your arm will be sore for several weeks. Your surgeon along with the rehabilitation team will work with you to start your rehabilitation. They will work with you on exercises that you will do at home as well as in the clinic that will help you recover. Total recovery is patient specifi c, but generally ranges from three to six months.
Working with a physical therapist will be critical in your total recovery from shoulder replacement surgery. Your rehabilitation schedule may start as soon as the day of surgery while you are in the hospital. You will continue to work with a physical therapy team once you leave the hospital. Your surgeon’s offi ce will set this up for you. You will be given exercises to perform at home, which are designed to increase your range of motion, mobility and strength. Your surgeon will provide you with a list of “do’s and don’ts” after surgery and your rehabilitation team will work with you to design a specifi c program based on your individual situation.
There are several different parts that make up a shoulder replacement all being of biocompatible materials. Most humeral heads are made of cobalt chrome, stems are generally made up of titanium to promote osteogenisis and the glenoid component is generally made up of titanium and/or polyethylene.
Overall, data shows shoulder replacement implants to have average survivorship of 90 to 95% at 10 years after surgery and approximately 80% 20 years after surgery.
Shoulder replacements are the third most common joint replacement. New advances in joint replacement have made shoulder replacement a very successful surgery. It is estimated that about 170 americans per million received a shoulder replacement in 2012.
Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. Shoulder replacement surgery was fi rst performed in the United States in the 1950s to treat severe shoulder fractures. Today, about 53,000 people in the U.S. have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality (www.ahrq.gov).