About Shoulder Replacement

ABOUT SHOULDER REPLACEMENT

Replacement of an arthritic or injured shoulder is less common than knee or hip replacement. However, shoulder replacement typically offers all the same benefits as those procedures — including joint pain relief and the restoration of more normal joint movement.

Restoring your movement is particularly important in the shoulder, because it’s the mechanism that allows your arm to rotate in every direction. If you’re experiencing severe shoulder pain and reduced shoulder movement, there are probably many daily activities you can no longer do — or do as comfortably — as before your shoulder problems began. This may mean you’re ready to consider shoulder replacement surgery.

In shoulder replacement surgery, the artificial shoulder joint can have either two or three parts, depending on the type of surgery required.

The humeral component (metal)
The humeral head component (metal)
The glenoid component (plastic) replaces the surface of the socket

There are two types of shoulder replacement procedures:

Partial shoulder replacement is performed when the glenoid socket is intact and does not need to be replaced. In this procedure, the humeral component is implanted, and the humeral head is replaced.
Total shoulder replacement is performed when the glenoid socket is damaged and needs to be replaced. All three shoulder joint components are used in this procedure.

What’s involved in shoulder surgery?

Certain parts of your shoulder joint are removed and replaced with a plastic or metal device called a prosthesis, or artificial joint. The artificial shoulder joint can have either two or three parts, depending on the type of surgery required.

The humeral component (metal) is implanted in the humerus, or upper arm bone.
The humeral head component (metal) replaces the humeral head at the top of the humerus.
The glenoid component (plastic) replaces the surface of the glenoid socket, or shoulder socket.

Partial Shoulder Replacement
This procedure is performed when the glenoid socket is intact and does not need to be replaced. In this procedure, the humeral component is implanted, and the humeral head is replaced.
Total Shoulder Replacement
Total joint replacement is performed when the glenoid socket is damaged and needs to be replaced. All three shoulder joint components are used in this procedure.

CONSIDERING SHOULDER REPLACEMENT SURGERY?

Circumstances vary, but generally patients are considered for total joint replacement if:

Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
Pain is not relieved by more conservative methods of treatment — such as medications (including, for the shoulder, injections of cortisone, a powerful anti-inflammatory medication) and physical therapy — and/or by restricting activities
Stiffness in the joint is marked and, in the shoulder, significantly limits range of motion of the arm
X-rays show advanced arthritis or other problems

SHOULDER REPLACEMENT FAQs

What is a shoulder replacement?

Also called arthroplasty, shoulder replacement is a surgical procedure in which the damaged or diseased joint is removed and replaced by an artificial shoulder implant (prosthesis) that is designed move like a normal, healthy joint.

How "bad" does my joint pain have to get before I consider joint replacement?

This is a very personal decision that only you can make, with the help of an orthopaedic surgeon’s evaluation of your pain and its affect on your daily life.

Why do some people need joint replacement?

When other treatment options no longer provide relief, joint replacement may be recommended — not only to relieve pain but also to prevent the disability it can cause. For example, experiencing joint pain day after day without relief can lead to “staying off” the joint — which often weakens the muscles around it so it becomes even more difficult to move. Your orthopaedic surgeon will tell you whether you might benefit from joint replacement and explain the reasons why it may, or may not, be right for you at this time.

What happens during shoulder replacement surgery?

The humeral component (metal) is implanted in the humerus, or upper arm bone.
The humeral head component (metal) replaces the humeral head at the top of the humerus.
The glenoid component (plastic) replaces the surface of the glenoid socket, or shoulder socket.

If I decide to have a joint replacement, what will I need to do before the surgery?

You’ll need routine blood tests, urinalysis, a physical examination, and, if you’re over 50 or your doctor thinks they’re advisable, an electrocardiogram (EKG) and chest X-ray as well. Your doctor or the hospital where you’ll have the surgery may perform these preoperative tests and evaluations. You may also be asked to donate blood preoperatively or to have a designated donor — usually a family member or relative — do this. Your doctor or orthopaedic surgeon will specify exactly which tests and evaluations you will need and when you should have them. He or she may also recommend that you take an iron supplement before your surgery, and you may be asked to stop taking certain medications — for example, aspirin and other medications that thin the blood. Your doctor or orthopaedic surgeon will also specify how these and any other medication concerns apply to you. Finally, your doctor may advise you not to eat or drink after midnight on the day your surgery takes place.

What do I need to know about postoperative recovery in the hospital?

On the first day after your surgery, you may be able to get out of bed and begin physical and occupational therapy, typically several brief sessions a day. Usually a case manager is assigned to work with you as you move through your rehabilitation routines. When you’re ready for discharge, the decision will be made concerning whether you can best continue to recover at home or in another facility where you may receive specialized rehabilitative help. If you do go to another facility, the goal will be to return you to your home, able to move about with a safe level of independence, within three to five days.

What can I expect in the first days after I am discharged?

You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. But soon you will likely get a routine going and gain confidence in your new joint — the start of a new life with less pain. (As with any surgery, you’ll probably take pain medication for a few days while you are healing.) You’ll also be in touch with your doctor or orthopaedic surgeon, as well as your case manager, so take advantage of opportunities to ask questions or discuss concerns as well as to report on your progress.

Will I be able to go back to a normal daily routine, such as driving and going to work?

This is a decision that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines that your doctor may give you:

You should have no restrictions on leaving your home as long as your safety and comfort are assured.
Don’t tire yourself out — a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.

When to resume driving a car, going to work, and/or participating in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopaedic surgeon’s advice and recommendations.

Are there activities I cannot do after shoulder replacement surgery?

When fully recovered, most people with artificial shoulders can return to work and normal daily activities without any problems. Keep in mind, however, that certain activities could affect how long your artificial shoulder will last and how well it will perform. A good rule of thumb is that your physical activities should not cause pain, including pain felt later. You should also not jar your joint or push it to its most extreme range of motion. If, for example, you are considering doing any of the following activities, you should discuss them first with your doctor or orthopaedic surgeon:

Any activity involving lifting or pushing heavy objects
Any activity that places excessive stress on your shoulder joint
Hammering and other forceful arm/shoulder movements
Boxing and other arm/shoulder impact sports