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Shoulder Replacement Surgery

If conservative, non-surgical treatments, such as physical therapy, medications and lifestyle modifications have been unsuccessful in relieving your shoulder pain and mobility, a shoulder replacement surgery may be an option. A full shoulder replacement is known as total shoulder arthroplasty. It can be a highly beneficial surgical procedure to treat advanced shoulder arthritis and severe shoulder injury. The expert team of orthopedic surgeons at Banner Health are here to ensure you get the best treatment possible for your pain or injury.

What is shoulder replacement surgery?

Shoulder replacement surgery is a procedure in which the damaged or diseased parts of the shoulder joint are replaced with artificial components. The surgery involves removing the damaged parts of the shoulder joint, including the ball (head of the humerus) and socket (glenoid), and replacing them with prosthetic components made of metal, plastic or a combination of materials. The specific type of shoulder replacement surgery needed depends on factors such as the condition of the patient's joint and the underlying causes being addressed.

This procedure can improve both your shoulder discomfort and range of motion. If you are dealing with chronic shoulder pain, total or partial shoulder replacement can dramatically improve your quality of life.

Types of shoulder replacement surgery

The nature of your injury or pain will help determine which type of surgery is best for you. Your doctor will recommend the safest solution that preserves as many of your natural body parts as possible and improves your quality of life after surgery.

Partial shoulder replacement – is also known as hemiarthroplasty. "Hemi" means partial. This procedure replaces either the ball or the socket of the joint with an artificial part. Which part is replaced depends on where the damage in your joint is found. The most common partial shoulder replacement is for the humeral head (top of the humerus bone).

Anatomic total shoulder replacement (traditional or conventional) – the damaged parts of the shoulder (portions of the ball-and-socket joint) are removed and replaced with artificial parts. These parts are typically made of a combination of metals, such as titanium and cobalt chrome, and medical grade plastics. This surgery is effective for people with a functional rotator cuff. It can help those who have osteoarthritis or other conditions that damage the joint.

Reverse total shoulder replacement – the damaged ball-and-socket joint surfaces are removed. Artificial parts are then used to replace them. However, the location of these parts is reversed. The original socket is replaced with a ball and the humeral head is replaced with a socket. This orientation provides more stability in cases where rotator cuff and other soft tissues are severely damaged or weakened. It relies primarily on the deltoid muscle to control the motion of the joint. This is the most common type of shoulder replacement surgery performed.

What conditions could require shoulder replacement surgery?

There are several conditions that may create a need for a partial or full shoulder arthroplasty. These conditions range from degenerative (wear and tear conditions) to acute traumatic injuries.

  • Osteoarthritis – an age-related condition caused by years of wear and tear on the cartilage that cushions the shoulder bones.
  • Rheumatoid arthritis – a disease that causes inflammation and thickening of the shoulder joint, which damages cartilage. This can lead to pain and loss of motion.
  • Post-traumatic arthritis – a form of osteoarthritis that develops rapidly in a joint due to an injury, such as a bone fracture or dislocation. The damage caused by the injury triggers the onset of arthritis in the affected joint.
  • Rotator cuff tear – a severe tear in the muscles and tendons in the shoulder. This can cause pain and weakness, and in some cases, it may lead to arthritis (rotator cuff arthropathy) or damage to the shoulder joint cartilage.
  • Avascular necrosis – A condition that causes a loss of blood supply to the bones that can lead to joint damage and pain.
  • Severe fractures – damage and breaks to the upper arm bone. This can lead to interruption of blood flow, stiffness, pain, weakness and loss of function. 

Benefits of shoulder replacement surgery

Many people who undergo shoulder replacement surgery experience:

  • Relief from chronic shoulder pain.
  • Improved range of motion: Shoulder replacement surgery can restore mobility and flexibility, enabling individuals to perform daily activities, reach overhead, lift objects and engage in physical activities with greater ease.
  • Enhanced function: This enables individuals to perform tasks such as dressing, grooming and carrying out household chores independently.
  • Increased strength: After shoulder replacement surgery, physical therapy and rehabilitation contribute to better joint stability, enhanced mobility and increased overall physical strength.
  • Restored quality of life: Shoulder replacement surgery can restore functionality, reduce pain and improve independence, leading to a higher quality of life and a return to activities that were once challenging or impossible.

Successful surgery can help people regain the ability to perform daily activities, participate in sports or hobbies and enjoy a more active lifestyle.

Preparing for shoulder replacement surgery

Before surgery, you will undergo a thorough medical evaluation. This typically includes a review of your medical history, a physical exam, and could include additional tests such as blood tests, X-rays or imaging scans. These help your surgical team assess your overall health and identify any potential risk factors or complications.

Here are some tips to for preparation:

  • Tell your doctor about any pre-existing medical conditions, allergies or previous surgeries you have had.
  • Provide a list of all medications you are currently taking, including prescription drugs, over-the-counter medications and supplements. Your surgical team will evaluate the medications and let you know on which ones should be temporarily stopped or adjusted before the surgery.
  • Quit smoking. Smoking can interfere with your healing process and increase the risk of complications after surgery. Your surgical team can provide resources and support to help you quit smoking, if needed.
  • Review the pre-operative instructions from your surgical team. These instructions may include guidelines on fasting before surgery, showering with antibacterial soap and avoiding certain medications or supplements in the days leading up to the procedure. Carefully following these instructions will help ensure your safety.
  • Arrange for support. You will need assistance at home following the surgery, especially during the initial days or weeks when mobility may be limited. Your family or friends can help with daily living activities, transportation and emotional support during your recovery.
  • Make your home safe and accessible. This may involve removing obstacles, arranging furniture to accommodate limited mobility and ensuring necessary items are within easy reach. Items like reachers, grab bars or shower chairs may also be helpful.
  • Address any concerns or anxieties with your surgical team and seek support from loved ones or counseling, if needed. Fully understanding the procedure and having realistic expectations can help ease some anxiety.

By planning and being well-prepared for shoulder replacement surgery, you can contribute to a smoother surgical experience and optimize your chances of a successful recovery. Following your surgical team's advice and actively taking part in preparation will help ensure the best possible outcomes.

What to expect during shoulder replacement surgery

Before the surgery begins, anesthesia will be administered to ensure your comfort throughout the procedure. You will receive general anesthesia (where you are unconscious), and in some cases you may also receive regional anesthesia such as a nerve block, to numb the shoulder and surrounding area.

Once the anesthesia has taken effect, your surgeon will make an incision over the shoulder joint. The size and location of the incision may vary depending on which procedure you are having and your surgeon's preference. The incision is typically made on the front or side of the shoulder.

Your surgeon will carefully separate your muscles and tissues to access your affected shoulder joint.

The damaged or diseased parts of the shoulder joint are then removed. Your surgeon may trim or reshape the upper arm bone (humerus) and shoulder socket (glenoid) to fit the prosthetic components.

Your surgeon will insert the prosthetic components into the prepared bone surfaces. These components can vary depending on the type of shoulder replacement being performed and are secured in place using cement or press-fit techniques.

Once the prosthetic components are properly positioned, the surgeon will close the incision using sutures or staples. The wound is then dressed with sterile bandages to help with healing.

After the surgery, you will be moved to the recovery room where medical staff will monitor vital signs and ensure a smooth transition from the anesthesia. Medication to manage pain may be provided as needed.

How long your surgery will take can vary depending on complexity, the type of shoulder replacement being performed and other factors. Typically, the procedure takes a few hours to complete.

Recovering from shoulder replacement surgery

Your hospital stay can vary. Typically, patients will go home same day after shoulder replacement surgery. However, some patients may stay in the hospital for up to three days depending on the specific type of shoulder replacement surgery that was had and individual factors like other medical conditions and support at home.

It’s normal to experience pain and discomfort after surgery. Your surgical team will prescribe pain medications to help manage pain during the recovery period. It is important to follow the prescribed medication schedule. Be sure to share any concerns you have or changes in pain levels with your doctor.

Depending on the surgery performed, your shoulder and arm will be put in a sling or special shoulder immobilizer. Your surgeon will also give you instructions on how and when you can start moving your arm.

Physical therapy is highly recommended. You will typically begin physical therapy shortly after surgery and it will continue for several weeks or months. Physical therapy may be done on your own at home or with the assistance of a physical therapist.

You will also be given range of motion exercises to perform at home. These exercises will help prevent stiffness, improve joint mobility and promote healing. It is important to follow the prescribed exercise regimen and let your physical therapist know if you have any questions, concerns or difficulties.

It generally takes about eight weeks after surgery to fully recover. It may also be several months before full strength and mobility are restored but pain should subside very quickly after surgery.

In most cases, gently resuming daily activities will be possible in two to six weeks. It typically takes 10-12 weeks for patients to return to full activity, including playing sports, after following post-op rehabilitation direction. It can be approximately six months before high impact activities such as golf or swimming can be done. Optimal performance may take up to a year.

During your recovery, you should avoid activities that could strain your shoulder joint, practice good posture, maintain a healthy weight and follow guidelines provided by the surgical team.

You’ll have regular follow-up appointments with your surgical team to monitor your progress, remove stitches or staples and evaluate how you’re healing. At these appointments, you can share concerns, ask questions and you’ll receive further guidance for your recovery and rehabilitation.

Potential risks and complications of shoulder replacement surgery

While shoulder replacement surgery is generally safe and effective, it is important to be aware of potential risks and complications. These can include:

  • Infection.
  • Excessive bleeding, during or after surgery.
  • Blood clots.
  • Nerve or blood vessel injury.
  • Implant problems, such as loosening, dislocation, or wear over time. These issues may require revision surgery to address.
  • Stiffness.
  • Allergic reactions.
  • Fracture.
  • Persistent pain or limited function.

You should discuss potential risks and complications with your surgeon before undergoing shoulder replacement surgery. The surgical team will provide personalized information, assess individual risk factors and take necessary precautions to minimize these risks.

Long-term outlook

Most patients end up with extremely functional shoulders. In fact, for many, increased range of motion and comfort will make your favorite activities much more comfortable.

More than 90% of shoulder replacements last at least 10 years. Advancements in technology and experience are improving outcomes and durability for all types of shoulder replacement surgery. If you are worried about your joint’s longevity, discuss options with your doctor.

It is important to note that individual outcomes can vary. Factors such as pre-existing conditions, your overall health, how well you follow post-operative instructions and your commitment to rehabilitation can influence the long-term outlook.

Openly communicating with your surgical team and going to regular follow-up appointments can help address any concerns you may have and ensure optimal long-term results.

Get started

If you are experiencing severe shoulder pain and limited mobility that is not improved by other measures, shoulder replacement surgery may be an option. A qualified orthopedic surgeon can determine if shoulder replacement surgery is the best treatment for your specific condition. While the decision to undergo shoulder replacement surgery is personal, it can potentially provide significant benefits and improve overall quality of life.

The first step in treating your shoulder pain is diagnosing the key problem. Schedule an appointment with a Banner Health orthopedic specialist to begin your journey. With help, you can reduce pain, restore mobility and return to your standard of living before you know it.