Shoulder Replacement Surgery

Your shoulder is a “ball and socket” joint. Normally the ball at the top of your humerus (upper arm bone) moves smoothly in the socket (the “glenoid”), which is part of your shoulder blade. However if the cartilage that lines your joint is damaged, or worn away by arthritis, the shoulder can become painful and stiff.

Osteoarthritis (“wear and tear”) of the ball and socket part of the shoulder joint can happen later in life and sometimes relates to a previous shoulder injury. Rheumatoid arthritis is an inflammatory disease which can damage the shoulder joint. In some people wear of the shoulder joint is secondary to damage to the stabilising rotator cuff tendons/muscles of the shoulder.

Osteoarthritis of the shoulder is diagnosed by X-ray. You will also be examined by an experienced clinician who will assess how the changes seen on X-ray are limiting your shoulder movement. You will be asked about your shoulder pain and how this is affecting your life. It may also sometimes be necessary to have an ultrasound or MRI scan to assess the state of the shoulder tendons, or a CT scan to further examine the bone quality around the shoulder.

It may be helpful to try physiotherapy at first with the aim of improving your range of movement, muscle strength and overall upper limb function. Regular pain killers and/or non-steroidal anti-inflammatory medication may help to control your pain. In some cases a steroid injection may be tried. However, it may be decided that shoulder replacement is the best option for you.

There are a number of types of shoulder replacement: 1. Partial shoulder replacement (also called a hemiarthroplasty) – this is where only part of the joint is replaced, usually just the ball at the top of the arm. Often a “resurfacing” technique is used rather than fully replacing the ball part 2. Total shoulder replacement (also called shoulder arthroplasty) – this is where both the ball and socket parts of the joints are replaced 3. Reversed shoulder replacement – this is where a ball is attached to your shoulder blade and a socket is attached to the top of the arm. This is usually done if there is significant damage to the supporting tendons of the shoulder (the “rotator cuff”) as well as arthritis

Shoulder replacement usually takes several hours. Once you have been anaesthetised, the surgeon will make a cut down the front of your shoulder. Some of the humeral head (the “ball”) will be removed and an artificial ball on a stem will be fixed with special cement. Alternatively the ball part will be reshaped and given a new artificial surface on the outside. The surface of the socket will then be prepared and a new artificial socket will be fixed in place, if required. To allow access to the shoulder a tendon called subscapularis at the front of the shoulder is cut. At the end of the operation this tendon will be reattached, and the skin cut will be closed with stitches. The wound will be covered with a dressing.

A shoulder replacement is very likely to improve your pain at rest. It may also increase your range of shoulder movement, and improve your ability to carry out functional tasks, although this will depend on how stiff and weak your shoulder was before your surgery.

A shoulder replacement is very likely to improve your pain at rest. It may also increase your range of shoulder movement, and improve your ability to carry out functional tasks, although this will depend on how stiff and weak your shoulder was before your surgery.

Some of the possible complications of shoulder replacement are listed below: Infection: Infection can complicate any surgery. It may be possible to treat this with antibiotics alone, but more commonly further surgery and removal of the replacement is necessary. The chance of this occurring is approximately 1%. Nerve and blood vessel injury: There is a very small risk (<1%) of damage to nerves or blood vessels around the shoulder. Loosening: It is possible that with time the shoulder replacement will lose its fixation to the bone. This may be associated with deep seated infection, but often occurs without any apparent cause. The chance of this occurring increases with time; there is approximately a 5-10% chance of this occurring within the first 10 years after surgery. Wear: Physical wear of the prosthesis (joint replacement) becomes a problem the longer it has been implanted. Wear debris may induce loosening of the components. Dislocation: Shoulder replacements may on occasions dislocate, although this is a fairly rare occurrence. In this event, a manipulation may have to be performed under a general anaesthetic. In rare instances revision surgery may be required. Cardiovascular problems such as heart attack and stroke, and also blood clot formation, can very occasionally be caused by anaesthesia and surgery. The anaesthetist will assess you and if there are any reasons why you would have an increased risk of these occurring, they will discuss this with you and take steps to minimise the risks.

You will need to attend a pre-admission clinic at the hospital so that an anaesthetist/the team can confirm that you are fit for a general anaesthetic. When you come into hospital for your shoulder replacement you are likely to stay for 2-3 days. After the surgery you will be fitted with a sling, and you are likely to require pain killers for a while.

You will be assessed by a physiotherapist on the ward. They will ensure you are able to undertake your post-operative exercises to maximize the benefit of the operation. You should continue these exercises as directed until you are assessed again by an outpatient therapist within two weeks of your discharge. You will need to continue wearing your sling for 3-6 weeks. You will need to follow specific instructions in order to protect the subscapularis tendon as it heals. Please keep the wounds dry to decrease the chance of infection. The wounds will be reviewed at your out-patient visit 2 weeks after surgery. The sutures will also be removed. Range of movement will be assessed at this visit to ensure you have not developed any post-operative stiffness. If you feel unwell or are concerned after the operation you should seek medical attention from your GP.

It is likely to take 3 to 6 months to fully recover from your surgery, and you may still continue to make improvement until 12-18 months post-op. The following is a guide of when you are allowed to restart your everyday tasks, hobbies and work. However, every case is different – you may be allowed to do some of these things, but you might not be able to. You may be given more specific advice by your physiotherapist or consultant. Light functional tasks – You can start light tasks at worktop height such as making a sandwich, at 3 weeks after surgery Driving – You can return to driving at 6 weeks after surgery as long as you have sufficient active movement and strength, and are able to fully control your vehicle Gardening – Light gardening, such as weeding, can be started at 6-8 weeks after surgery Swimming – Breast stroke at 6 weeks, free style at 3 months after surgery Bowls – 3-6 months after surgery Golf – 3 months after surgery Manual work – You can generally return to manual work by 3 months after surgery, although it depends on the nature of the work and your recovery rate