Shoulder Replacement Surgery

A stiff, painful arthritic shoulder can keep you from doing even simple things, like dressing yourself or carrying groceries. But there’s good news. A worn out shoulder can be replaced, just like a bad hip or knee. Shoulder replacement is safe and reliable. Surgery relieves the pain and may let you return to many of your normal activities.

Over time, your shoulder joint may have become worn and arthritic. Overuse of the shoulder may aggravate the problem. Or you may have a large rotator cuff tear that could not be repaired and it eventually turned into shoulder arthritis. If you’ve had a bad fall, you may have torn or broken your shoulder.

Whatever the cause, your shoulder is stiff and painful. You may not be able to use your arm to reach behind your back or over your head. Your pain may be worse at night, when you’re active, or when it’s cold and damp. If heat, rest, exercise, and medication haven’t relieved your pain, your doctor may be recommending replacement surgery.

The primary reason to have a shoulder replacement surgery is to relieve pain. It may give you more strength and movement in your shoulder as well. During surgery, your surgeon replaces all or part of your problem shoulder with an artificial joint, called a prosthesis. The prosthesis replaces the rough, worn parts of your shoulder with smooth metal and plastic parts.

What is a reverse total shoulder?

A reverse total shoulder is a replacement that puts the ball where the cup of the joint used to be and put the cup where the ball of the joint used to be. So the ball and the cup are reversed. This changes the mechanics of the shoulder joint so that it will work when the rotator cuff tendons are not working normally. So for patients who have a torn rotator cuff tendon and have shoulder arthritis, the surgeon may decide to use a reverse total shoulder implant.

How is the reverse total shoulder different than the normal total shoulder?

The normal total shoulder replacement uses the same mechanics as a shoulder without arthritis. It depends on the rotator cuff tendons and muscles to rotate and elevate the arm. The reverse total shoulder replacement can work without a normal rotator cuff tendon, so for patients with a tear of the tendon that cannot be fixed, this replacement will allow the patient to raise the arm away from their body.

As with most things in life, there are tradeoffs to using a reverse total shoulder compared to a normal total shoulder replacement. The strength and function of the average patient with a normal total shoulder is better than the average patient with a reverse total shoulder. There are more complications associated with a reverse total shoulder than a normal total shoulder. Some of these complications are minor, like more blood loss after surgery, higher bleeding rates, or lengthening of the arm by an inch or two. Other complications are more serious, such as nerve injury, stress fractures, dislocation, implant loosening, or infection.

The shape of the arm also changes after a reverse total shoulder. Instead of being more round, the end of the shoulder can look more squared off. Patients also have less rotation of the arm behind their back after a reverse compared to patients with a normal shoulder replacement.
It is natural to feel anxious about surgery. The following questions and answers may help ease some of your concerns.

Will my pain go away?

Chances are very good that once your shoulder heals, you’ll have little or no pain. The average pain for my patients prior to surgery is an 8 out of 10 and after surgery the average is a 2 out of 10.

Will I be able to do more?

How much strength and movement you regain depends on your shoulder problem. If the muscles and other soft tissue are healthy, your shoulder may be stronger and more flexible after replacement surgery. Generally the more motion you have before surgery, the more motion you will have afterwards.

How long will the surgery take?

Removing the damaged shoulder and putting in the new joint usually takes 2 hours.

How long will I be in the hospital?

Most patients are able to go home the day after their surgery.

How much rehabilitation will I have to do after surgery?

You will need 4-6 months of therapy after surgery.

How long will I need to use a sling after surgery?

If you have a normal total shoulder, your arm will be in a sling for 6 weeks. If you have a reverse total shoulder, your arm will be in a sling for 2-6 weeks.

About how long will my new shoulder last?

A new shoulder can last 10-15 years, as long as you take care of it and have no complications.

Deciding if Surgery is Right for You

Replacement surgery is recommended only if other treatment options do not relieve symptoms. Your orthopaedic surgeon will discuss your symptoms with you, examine your shoulder, and order tests to determine if replacement surgery is the best answer for you.