Total shoulder replacement is a very successful procedure to reduce pain and restore mobility in patients with end-stage shoulder arthritis or after a severe shoulder fracture.
Shoulder replacement surgery relieves pain, improves motion, and restores strength and function to the shoulder. By one year from surgery the vast majority of patients have returned to playing golf or tennis, swimming, doing yoga, yardwork, or even lifting weights.
What is shoulder replacement surgery?
Total shoulder replacement, also known as total shoulder arthroplasty, is the removal of arthritic portions of the shoulder joint which are replaced with metal and polyethylene implants. This helps to reduce pain and restore range of motion. It is very successful for treating the severe pain, stiffness, and grinding caused by shoulder arthritis.
Shoulder arthritis is a condition in which the smooth cartilage in the shoulder joint breaks up and peels away. In a healthy shoulder, cartilage allows the bones to glide almost without friction. When these cartilage surfaces disappear, the bones come into direct contact, increasing friction and causing pain.
What causes the conditions treated by shoulder replacement surgery?
There are two basic types of arthritis that affect the shoulder.
Osteoarthritis (OA): This is due to wear and tear on the shoulder. Osteoarthritis in the shoulder is more common in exceptionally active people (even at younger ages), such as tennis players, weightlifters, gymnasts and other athletes who put continual pressure on their shoulders. People that work overhead like pipefitters, plumbers, and electricians are also prone to shoulder OA.
Inflammatory arthritis (IA): This is an umbrella term for several autoimmune diseases. The most common of these is rheumatoid arthritis. These patients can also benefit from shoulder replacement but they do have higher risks of complications.
Who performs shoulder replacements?
Sports Medicine specialists are often specially trained at both standard and reverse shoulder replacements. At Bone and Joint Specialists of Winchester, Dr. James Larson and Dr. Steven Pancio perform total shoulder replacements and reverse shoulder replacements. Dr. Richard Patterson performs total shoulder replacements as well.
How do I know if I need a shoulder replacement?
People who have developed painful end-stage arthritis are candidates for shoulder replacement surgery. The most important parts of deciding to replace the shoulder are how much pain and loss of function the arthritis causes. If your xrays show arthritis but you have minimal pain along with good strength and motion, a replacement can often be delayed until the pain is more severe.
Diagnosing shoulder arthritis
The basic diagnosis of shoulder arthritis is made with plain X-Rays. If you’ve had X-Rays at an outside facility, our physicians may request that you get new ones in our office. This is usually because specific angles are required to see the shoulder joint clearly, and other offices my not have obtained these specialized views of the shoulder. We may also need radiographs on our own system in order to properly plan for surgery.
Sometimes we may also order an MRI to check for rotator cuff tears. Or a CT scan may be ordered so that we can plan for any bone loss or create patient-specific guides for your surgery.
Can shoulder replacements be performed as an outpatient?
Yes, both standard and reverse shoulder replacements can be performed as an outpatient. This is the result of decades of refinement to surgical techniques and improvements to anesthesia. These have greatly reduced the risks of bleeding and other complications, allowing you to have your surgery and safely go home with friends or family the same day. The decision to have shoulder replacement as an outpatient will be made between you and your surgeon and depends on your other medical conditions as well as home support.
What are other options to shoulder replacement?
We always reserve surgery for when other options have failed to relive the pain of arthritis. Other treatments for shoulder arthritis include
- Steroid injections
- PRP injections
- Physical Therapy
- Oral Anti-Inflammatories
How is shoulder replacement performed?
In traditional shoulder replacement surgery, the damaged humeral head (the ball of the joint) is replaced with a metal ball, and the glenoid cavity (the joint socket) is replaced with a smooth plastic cup. This metal-on-plastic implant system (rather than metal-on-metal) is used in virtually all shoulder replacement. In some patients, such as those with severe shoulder fractures of the humeral head, a partial shoulder replacement, or hemiarthroplasty, may be recommended.
Anesthesia for shoulder replacement surgery
During a total shoulder replacement, the patient will usually have both regional anesthesia and general anesthesia. Regional anesthesia is usually performed by administration of a nerve block to the shoulder. This results in the entire arm being numb during the surgery. That means you need less anesthesia and narcotic medications during surgery. And that helps prevent nausea, vomiting, grogginess, and other side effects of the anesthesia.
How long does a shoulder replacement take?
While an uncomplicated shoulder replacement usually takes less than an hour, it can take up to a couple of hours in some cases. If you have severe arthritis, osteoporosis, large bone spurs, loss of bone, or severe contractures of the joint, surgery may be longer than usual so that these problems can be properly addressed.
What are the risks of a shoulder replacement?
We always reserve surgery for when other options have failed to relive the pain of arthritis. Other treatments for shoulder arthritis include
- dislocation (the ball slipping out of the socket)
- infection
- nerve damage
- implant loosening
- stiffness*
*An arthritic shoulder is often very tight prior to surgery. Physical therapy after surgery is usually needed to restore motion back to normal. Continuous physical therapy efforts are usually effective in restoring shoulder motion and strength.
How long does it take to recover from a shoulder replacement?
After a standard shoulder replacement, you will need to be in a sling for about 6 weeks after surgery. This is to allow the rotator cuff to heal, otherwise the new shoulder will be weak and more likely to dislocate. It may be several months before a patient may do heavy labor or strenuous strength exercises.
Time-lime for recovery after shoulder replacement
- After Six weeks – The patient may use the whole arm, including shoulder, for light activity.
- After Eight weeks – The patient may begin unrestricted, active use of the arm and shoulder.
- By Three months – Most patients have only mild pain. Range of motion has improved to about half or three quarters of normal. They usually still have to work on strengthening and experience some weakness.
- Six months – Most patients are pain-free (although they may experience pain during certain weather conditions. Motion and strength are approaching normal.
- One year – Approximately 95% of shoulder replacement patients will be pain-free. The remaining 5% will usually have no more than a weather-related ache or an occasional pain due to excessive activity. Likewise, there will probably not be significant strength limitations, depending on the condition of the deltoid and rotator cuff, particularly if both these muscle groups were normal before surgery.
Returning to work
The exact time a person can return to work depends greatly on the motion and strength of the shoulder and how the patient is progressing. But it usually takes two to three weeks to return to desk though don’t expect to type with the surgical arm. Four months or more of recovery is required for heavier, physical labor.
In all cases, proper and extensive postoperative rehabilitation are key factors in achieving the maximum benefit of shoulder replacement surgery.
What is a reverse shoulder replacement?
A reverse shoulder replacement is a design in which the positions of the ball and socket are switched: A metal ball is placed where the patient’s own natural socket was, and a plastic socket implant is placed on the head of the humeral head. It might be better called an “inverse” shoulder replacement. We don’t simply put the old parts in new positions, these implants are specific to this style of replacement.
The reverse shoulder replacement is done for a few reasons, usually involving the rotator cuff. People with arthritis AND a tear of the rotator cuff, or people with an irreparable tear of the rotator cuff and loss of motion are candidates for a reverse shoulder replacement. This reverse design has more stability and does not need the tendons to hold it in place. It’s motion is controlled by the deltoid muscle rather than the rotator cuff tendon.
You can find out more about the Reverse Shoulder Replacement HERE ( HYPERLINK)
