Whether you’re pushing, pulling or lifting things, your shoulders are hard at work. As one of the most mobile joints in the human body, they are also one of the most prone to instability and injury.
While shoulder pain and injury are often caused by athletic activities involving excessive, repetitive type motions, they can also occur during everyday activities—particularly if the shoulder joint is affected by osteoarthritis. Pain can come on gradually or abruptly and can range from mild to severe. Other symptoms include loss of motion, grinding, and swelling around the shoulder.
If you are suffering from the pain and loss of function associated with arthritis of the shoulder and nonsurgical methods aren’t cutting it, shoulder replacement surgery may be your best treatment option.
What is shoulder replacement surgery?
Total shoulder replacement, also known as arthroplasty, is a procedure that involves replacing the shoulder joint surfaces with artificial parts to decrease pain and improve range of motion for patients with advanced arthritis. As a result, overall quality of life and function can be significantly improved.
The shoulder is complex in nature and an arthritic joint can be affected by much more then osteoarthritis. Often the rotator cuff can be torn or dysfunctional leading to weakness and instability of the joint. Bone loss and deformity can also be present. To appropriately treat these conditions there are, in general, two types of total shoulder replacements – anatomic (also known as traditional or conventional) and reverse shoulder arthroplasty.
“Both options are very successful procedures and can predictably improve patient pain, function and quality of life, but they are done for very different reasons,” said Samuel Harmsen, MD, an orthopedic surgeon and complex shoulder specialist with TOCA at Banner Health in Arizona. “The decision of whether to perform an anatomic or reverse shoulder replacement is based on several criteria, including the severity and type of arthritis, integrity of the rotator cuff, bone quality, presence of bone loss—even the individual surgeon’s experience and preference can play a role. Just as important in the decision process are the age, activity level and particularly the goals and expectations of the patient.”
Anatomic Total Shoulder Replacement
In an anatomic shoulder replacement, the damaged ball-and-socket joint surfaces of the shoulder are removed and replaced with artificial parts. The ball joint, or humeral head, is replaced with a metal ball, and the socket, or glenoid cavity, is replaced with a smooth plastic socket. This type of procedure is helpful for patients with a functional rotator cuff who suffer from osteoarthritis or other related conditions of the shoulder that cannot be successfully managed with nonsurgical treatments.
Reverse Total Shoulder Replacement
In a reverse shoulder replacement, the damaged ball-and-socket joint surfaces of the shoulder are also removed and replaced with artificial parts, but the location of those parts is reversed.
“The metal ball is placed where the patient’s socket was, and the plastic socket is placed on the humerus where the ball used to be,” Dr. Harmsen said. “This provides stability across the joint when the dysfunctional rotator cuff is unable to do so, allowing range of motion and strength to be restored in the shoulder.”
This type of procedure is typically done for patients with a dysfunctional or torn rotator cuff who have developed arthritis as a result. It can also be successfully used in patients with significant bone loss, inflammatory arthropathy, fractures and revision of prior replacement.
What are the advantages of shoulder replacement surgery?
Most shoulder replacement surgeries are successful and more than 90% of shoulder replacements last at least 10 years. Many patients end up with extremely functional shoulders and can return to daily activities and low-impact sports without pain. In fact, nearly all shoulder replacement patients under age 55 return to sports.
“90 to 95 percent of patients are very happy with their results,” Dr. Harmsen said. “Complete or near complete pain relief is expected. Range of motion and strength also predictably improve. Though it can take up to a year to see maximal improvement, most patients are able to return to their desired functional levels by 10 to 12 weeks post-operatively. This includes a return to nearly all lifestyles, sports and activity levels.”
What are the disadvantages of shoulder replacement surgery?
Complications are relatively rare, occurring in 3-8% of patients, and include infection, fracture, instability, loosening of the prosthesis, continued pain and weakness, tearing of the rotator cuff and the need for revision surgery.
What can I expect post-surgery?
Both anatomic and reverse shoulder replacements typically involve an overnight hospital stay but can also be successfully performed as an outpatient surgery in select patients.
“Most people are under the assumption from friends that shoulder surgery is quite painful and requires a long recovery period, but that’s typically not the case with shoulder replacement surgery,” Dr. Harmsen said. “It’s a fairly easy recovery and not very painful, particularly compared to rotator cuff repair.”
Following surgery, you may be in a sling or a special ‘shoulder immobilizer' depending on the surgery performed and your surgeon’s preference. You will be given specific instructions about whether you are allowed to move your arm immediately after the surgery. Your surgeon may also prescribe physical therapy to speed up recovery and improve joint function.
It can take generally 3 months or more for patients to recover and several more months for patients to do strenuous activities and exercises. But Dr. Harmsen said recovery timelines can vary.
“Most of my patients are in a simple sling for three weeks, at which point the sling can be thrown away and gradual, self-directed motion and use of the arm for light activities is initiated. Physical therapy is generally started at 6 weeks and by 10 to 12 weeks advancement towards regular activities is allowed. However, some patients may have more advanced arthritis and associated conditions that require a longer recovery than others,” he said.
What are the alternative surgical options to shoulder replacement?
Although shoulder replacement is considered the definitive treatment for arthritis of the shoulder, an arthroscopic procedure designed to improve symptoms and delay shoulder replacement may be recommended for younger patients and those with less advanced disease. This treatment can be a successful alternative for specific patients and should be discussed with your surgeon to see if you are a candidate.
Are you considering shoulder surgery?
If you are considering a total shoulder replacement, finding a surgeon who has adequate experience and training in the specific type of surgery required is important for a successful outcome. Surgeons and facilities who perform over 30 to 50 shoulder replacements a year tend to have lower complications rates and better clinical outcomes when compared to lower volume surgeons.
Find an orthopedic surgeon
Are you looking for an orthopedic surgeon who specializes in shoulder pain and injuries? Our Banner Health surgeons use the most advanced arthroscopic and open surgical techniques available. Check out our list of orthopedic specialists at bannerhealth.com.