Shoulder Replacement Surgery
How will I know if I need to have shoulder replacement surgery?
Of the joint replacement procedures, shoulder replacement is the least performed. This probably speaks to the complexity of the joint. Each year in the U.S. around 53,000 people have a shoulder replacement. This compares with over 900,000 people having knee and hip replacement surgery.
This decision whether or not to have this surgery is usually a joint decision between you, your family members, your family doctor, and your Redwood Orthopaedic surgeon.
There isn’t a setlist of criteria that would qualify you to move forward or to opt-out of surgery. These are some characteristics of people who would be good candidates for shoulder replacement:
- Severe shoulder pain enters into everyday life, interfering with routine activities such as dressing, toileting, showering, even reaching into a cabinet.
- Loss of motion and weakness in the shoulder.
- Moderate to severe pain while sleeping, even preventing sleep.
- Failure for the injured shoulder to respond to other treatments such as corticosteroid injections, physical therapy, anti-inflammatory medications, and other conservative measures.
How is shoulder replacement surgery performed?
The methods used by your Redwood Orthopaedic surgeon will vary depending on if you are having a total replacement or partial. These are descriptions of the various options:
Total shoulder replacement
The most common method replaces the arthritic joint surfaces with a highly polished metal ball attached to a stem, along with a plastic socket. Patients who have bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.
These components have various sizes, and they are matched to your natural humerus head and shoulder socket. The metal ball and stem can be cemented or “press-fit” into the bone. If the bone is of good quality and able to fully accept the stem, we may opt for the press-fit method. If your bone is soft, however, we will place the stem with bone cement. In the majority of cases, the plastic socket (glenoid) is placed with bone cement.
Not all patients need a plastic socket if:
- The socket has good remaining cartilage
- The glenoid bone is severely deficient
- The rotator cuff tendons are irreparably torn
If you still have a normal socket, but the head of the humerus is severely fractured, we may opt to replace just the ball. This is usually replaced with a metal ball and stem, similar to the part used with a total shoulder replacement.
This may be a good choice when a patient has any of these traits:
- Arthritis that only involves the head of the humerus, with a socket that is still intact
- Shoulders with severely weakened bone in the socket
- Some shoulders with severely torn rotator cuff tendons and arthritis
This is the same as above, but the metal head is only a cap-like prosthesis without the stem pushed down into the humerus. This preserves natural bone. For younger patients or for very active patients this option avoids the risks of component wear and loosening that may occur with conventional head and stem replacements.
Reverse Total Shoulder Replacement
In reverse total shoulder replacement, the components are flipped. The metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.
Reverse total shoulder replacement is used for people who have:
- Completely torn rotator cuffs with severe arm weakness
- The effects of severe arthritis and rotator cuff tearing
- A previous shoulder replacement that failed
For patients with these characteristics, conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle with conventional methods.
How long does shoulder replacement surgery take?
The actual procedure to replace your shoulder joint with a prosthesis usually takes about 2-3 hours.
How do I prepare for shoulder replacement?
You prepare for this procedure as you would any surgery. That means stopping any anti-inflammatory medications and arthritis therapies, blood thinners, and most supplements — they can all cause excessive bleeding. If you smoke, you’ll need to stop for at least two weeks before and after surgery, as smoking constricts blood vessels and inhibits healing.
Your real preparation is for recovery. The use of your arm will be severely limited, and you need to plan for that. You’ll be staying in the hospital for 1-3 days after surgery. You won’t be able to drive until your shoulder regains normal motion and strength, so plan on getting help with driving. Any items you’ll need in your cabinets should be brought down, as you won’t be able to reach up for several weeks. You’ll need some assistance around the house for about six weeks after your surgery. If your dominant arm is being operated on, you should work with your non-dominant arm to perform normal activities such as brushing your teeth, buttoning a shirt, and so on.
What is recovery like after shoulder replacement surgery?
These are not simple recoveries. Part of this is pain; part of this is the inconvenience of basically not having the use of one arm for some time. This is a major surgical procedure, and it will involve some significant pain at times, especially early on. You’ll have prescription pain medication and possibly a pain pump. We’ll start you on rehabilitation right away, usually on the day of your surgery, which surprises most people. It’s good to have you up and moving as soon as possible. You’ll stay in the hospital for 1-3 days. You will be discharged with your arm in a sling that you will wear for anywhere from 2-4 weeks.
You will have limited arm function for one month after your surgery. You need to be careful and not push things. You cannot lift any objects that weigh more than one pound. You must not push or pull anything. This is the area where patients often diminish the returns of their replacement. Rushing to lift things and other movements can impact your overall recovery and the quality of your shoulder operation.
Most patients can return to gentle daily activities within two to six weeks. You cannot drive for up to six weeks.
It’s important to follow and perform the regimen of home exercises your physical therapist gives you. If you do so, in about six months you can get back to more vigorous activities, such as swimming or golf.
Schedule Your Consultation Today
If you’re interested in learning more about shoulder replacement surgery please contact us for a consultation at (707) 544-3400 or fill out our contact us form. We will discuss your needs and concerns, and determine your best course of action.