What is a shoulder replacement?

What is a shoulder replacement?

A shoulder replacement is surgery to replace your shoulder joint with an artificial one called a prosthesis. It is commonly used to treat severe shoulder arthritis or to replace a shoulder joint damaged by illness or injury.

How do our shoulders work?

The shoulder is a ball and socket joint made up of bones, joints, muscles, ligaments and tendons. It is the most moveable joint in the body and we use our shoulders during a wide range of activities, making it prone to injury.

There are three bones in the shoulder; the collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).

The shoulder has two important joints; the acromioclavicular joint that connects the upper part of the shoulder blade to the collarbone and the glenohumeral joint, the ball-and-socket joint that connects the upper arm to the shoulder blade. These joints allow us to move our shoulder in a wide range of movements.

To keep the shoulder joint stable, the bones of the shoulder are held in place by muscles, tendons, and ligaments. The rotator cuff is a large band of muscles and tendons that helps keep your shoulder joint stable and allows you to move your shoulder freely.

Why might I need a shoulder replacement?

You may need a shoulder replacement if your shoulder joint has been damaged by injury or diseases such as osteoarthritis or rheumatoid arthritis. Shoulder replacement surgery can also be used to treat a badly fractured shoulder, or tumour.

Your consultant may recommend shoulder replacement surgery if:

• You have moderate-to-severe pain with activity
• Your pain affects your sleep
• You cannot lift your affected arm to perform daily tasks, such as reaching high shelves, dressing, or brushing your hair
• You have pain and stiffness when lifting your affected arm above your head
• You have tried non-surgical treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and steroid injections
• Minor procedures such as a shoulder arthroscopy did not improve your symptoms

Who is a shoulder replacement suitable for?

Shoulder replacement surgery is normally suitable for anyone with severe damage to their shoulder joint that has not improved with other treatments.

Who cannot have shoulder replacement surgery?

Shoulder replacement surgery may not be recommended for you if:

• You are under 60 years of age — people under 60 tend to be more active and your shoulder may not last as long as it should, meaning revision surgery may be needed. For this reason, your consultant may recommend postponing your shoulder replacement surgery where possible
• You smoke
• You are very overweight or obese
• You have osteoporosis
• You have a condition that makes you prone to infection or poor wound healing
• You have damage to your shoulder socket
• You have severe, irreparable damage to your rotator cuff or deltoid muscle
• You have damage to the nerves that travel from the spine to the affected shoulder, arm or hand
• You have a high risk of falls due to conditions like dementia, Parkinson’s disease or alcoholism

Are there different types of shoulder replacement?

There are three main types of shoulder replacement surgery.

Anatomic shoulder replacement

During this type of surgery, both the ball and socket are replaced. The ball is normally replaced with a metal prosthesis and the socket with a plastic implant.

Reverse shoulder replacement

During a reverse shoulder replacement, both the ball and socket are replaced, but the implants are reversed. The ball is attached to the shoulder blade, and the socket is attached to the upper arm bone. This type of surgery may be used if your rotator cuff muscles are severely damaged.

Partial shoulder replacement

This type of surgery involves replacing only the ball part of the shoulder joint, but not the socket.

What are the benefits of having a shoulder replacement?

The main benefit of shoulder replacement surgery is reduced or alleviated shoulder pain. You may also have improved function and increased range of motion, meaning you may be able to use your shoulder and move it more freely after your shoulder replacement surgery.

What happens during a shoulder replacement?

Shoulder replacement surgery is normally carried out under general anaesthetic, meaning you’ll be asleep during the procedure.

Once your anaesthetic has taken effect:

• Your surgeon will make an incision (cut) on the front of your shoulder
• They will remove the damaged ball and socket
• The prosthetic ball and socket are implanted into the joint
• The prosthesis is fixed in place using bone cement
• Your incision is closed with glue or stitches

Shoulder replacement surgery normally takes between one and two hours.

Are there any risks or complications?

All surgery carries a risk of complications. Shoulder replacement surgery is a generally safe procedure, but occasionally, complications can occur. Your consultant will explain all the possible risks and complications of shoulder replacement surgery to you before your procedure to ensure you are fully informed about your surgery.

Potential risks of shoulder replacement surgery include:

• Blood clots or deep vein thrombosis (DVT)
• Chest infection
• Adverse reactions to the anaesthetic
• Infection inside the shoulder joint or at the incision site
• Damage to the surrounding nerves, tissues or blood vessels
• The prosthetic implants may move, loosen or wear down
• A build-up of scar tissue inside the shoulder
• Reduced range of motion, instability of the shoulder joint or shoulder stiffness
• The surgery may not relieve pain or other symptoms

What’s the recovery like?

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health, the type of surgery you had and your activity level before your surgery.

You can expect to spend two to three nights in hospital after your surgery. Full recovery from shoulder replacement surgery usually takes between three and six months, but may take up to a year.

Your arm will be in a sling for the first six weeks after your shoulder replacement, and you will need help with tasks such as bathing, housework, shopping and cooking. Arrange for someone to help you for the first few weeks after your surgery. You can also help ease your recovery by preparing your home in advance. Some things you can do include:

• Stock up on easy to prepare, non-perishable food and preparing single-portion meals in advance that can be heated up
• Remove anything you could trip over like low tables, rugs and electric cables
• Keep things you use regularly, like the TV remote control, glasses, books and medications, within easy reach

Depending on the job you do, you may be able to go back to work two to three weeks after your shoulder replacement surgery, though this may be much longer. Your consultant can give you an accurate recovery timeline based on your individual circumstances.

Your consultant will give you instructions on what to do during your recovery including pain management, wound care and exercises.

Pain management

You can expect to have some pain and swelling after your shoulder replacement surgery. Your consultant will prescribe medication to help manage this. Applying heat or ice packs a few times a day will also help relieve pain and reduce swelling.

Caring for your wound

Your healthcare team will give you instructions on caring for your surgical wound. Keep your incision clean and covered and follow instructions on changing the dressing. Check with your consultant when you can take a shower or bath.

Call the hospital immediately if your surgical wound is showing signs of infection such as yellow or green discharge, redness, warmth, swelling, or an unpleasant smell.

Exercise

Physiotherapy is a major part of your recovery from shoulder replacement surgery. Your physiotherapist will show you exercises to strengthen your muscles, increase your range of motion and prevent stiffness. Gentle exercise like walking is also beneficial during your recovery.

How long does a shoulder replacement last?

Approximately 90% of shoulder replacements last longer than 10 years and many last around 15 to 20 years.

Are there any alternatives to a shoulder replacement?

Deciding to have a shoulder replacement is a personal decision and one that only you can make. While shoulder replacement surgery has many benefits, as with all surgery, there are risks involved. Recovery from shoulder surgery is also lengthy and takes several months. Until you are ready to have shoulder replacement surgery, some non-surgical alternatives to consider include:

Medication

Over-the-counter painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve shoulder pain. Your consultant may prescribe a stronger medication if these aren’t effective.

Shoulder injections

Steroids or corticosteroids work by reducing inflammation, which in turn reduces pain. A steroid injection is given directly into the shoulder joint and can relieve symptoms for several weeks or months.

Other injections, include hyaluronan (hyaluronic acid) that may help lubricate the shoulder joint and relieve arthritis pain.

Platelet-rich plasma (PRP) uses your own blood to stimulate healing of damaged muscles, ligaments, tendons and joints. A sample of your blood is put in a centrifuge which separates the blood cells from the plasma, increasing the number of platelets, growth hormones, healing and anti-inflammatory properties. The sample is then injected back into your shoulder to aid healing.

Physiotherapy

Physiotherapy exercises focus on building muscle strength and increasing flexibility and range of motion. Your physiotherapist may also use techniques such as manual therapy, hydrotherapy, therapeutic ultrasound and transcutaneous nerve stimulation (TENS).

Summary

Shoulder replacement surgery is an operation to replace your damaged shoulder joint with a prosthesis. It is performed to reduce pain and restore movement and function. Shoulder replacement surgery can allow you to return to doing the activities you enjoy, and allow for greater independence and improved quality of life.