The human shoulder is a miracle of engineering, enabling an incredible range of motion. Unfortunately its durability is not unlimited, and some people can develop arthritis in this joint.
If the arthritis becomes severe, patients can experience pain and a limitation in function. If a patient has failed conservative management to eliminate pain and restore function, it may be time to consider shoulder replacement surgery. That’s where shoulder replacement with the team at Orthopedic Associates of Long Island could be the answer.
SHOULDER ANATOMY 101
First, let’s get into how the shoulder is constructed. It is a ball-and-socket joint. The humerus (upper arm bone) has a round end that fits into the curved structure on the outside of your shoulder blade, called the glenoid. Inside the joint is a layer of cartilage that provides cushioning so that the bones don’t rub against one another.
WHAT IS SHOULDER REPLACEMENT?
In a shoulder replacement, your Orthopedic Associates of Long Island orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with what will likely be a combination of metal and plastic. Shoulder replacement isn’t all the same.
WHAT ARE THE SHOULDER REPLACEMENT OPTIONS?
There are three shoulder replacement options:
TOTAL SHOULDER REPLACEMENT
This is the most common of these procedures. The ball at the top of your humerus is replaced with a metal ball that is attached to the remaining natural bone. The socket is cleaned out and replaced with a new plastic socket.
PARTIAL SHOULDER REPLACEMENT
If your shoulder socket cartilage is still intact, a partial shoulder replacement only replaces the end of the humerus with a metal ball. This can be done with or without a stem.
REVERSE SHOULDER REPLACEMENT
This is often the procedure if the patient also has a torn rotator cuff, or if a previous replacement didn’t work. Here, the metal ball is attached to your shoulder blade, and the socket is placed atop your humerus. This allows other muscles to replace the function of the rotator cuff.
BENEFITS OF UNDERGOING SHOULDER REPLACEMENT SURGERY
What are the benefits of using your shoulder without pain? What are the benefits of being able to use your shoulder at all? Those are the big changes that will happen with shoulder replacement. Shoulder replacement will once again allow the patient to use his or her shoulder normally, raising your arm above your head and reaching into cabinets and bookshelves above your head. That’s a big deal considering that just about every movement of our upper body involves the shoulder to some degree. These procedures are very successful.
CANDIDATES FOR A SHOULDER REPLACEMENT
Of the major joint replacement procedures, shoulder replacement is the least common. Each year in the U.S. around 53,000 people have shoulder replacement. This compares with over 900,000 people having knee and hip replacement surgery.
This decision whether or not to have this surgery is usually a joint decision between you, your family members, your family doctor, and your orthopedic surgeon.
These are some characteristics of people who would be good candidates for shoulder replacement:
- Severe shoulder pain enters into everyday life, interfering with routine activities such as dressing, toileting, showering, even reaching into a cabinet.
- Loss of motion and weakness in the shoulder.
- Moderate to severe pain while sleeping, even preventing sleep.
- Failure for the injured shoulder to respond to other treatments such as corticosteroid injections, physical therapy, anti-inflammatory medications, and other conservative measures.
HOW SUCCESSFUL IS SHOULDER REPLACEMENT SURGERY?
Total shoulder replacement is a very successful procedure. The 10-year survival rate for these prostheses is over 90 percent. The vast majority of patients are able to return to normal activities and low-impact sports without pain.
HOW TO PREPARE FOR SHOULDER REPLACEMENT SURGERY
Preparation for these surgeries is no different than with any surgery. You’ll stop taking anti-inflammatory medications and arthritis therapies, as they can cause bleeding. You’ll stop taking blood thinners. If you smoke, you’ll need to stop for at least two weeks prior to and after your surgery, as smoking inhibits wound healing.
You’ll be staying in the hospital for 1-2 days after surgery. You won’t be able to drive until your shoulder regains adequate motion and strength, so plan on getting help with driving. Any items you’ll need in your cabinets should be brought down, as you won’t be able to reach up for several weeks. You’ll need some assistance around the house for about six weeks after your surgery.
THE SHOULDER REPLACEMENT PROCEDURE
TOTAL SHOULDER REPLACEMENT
The most common method replaces the arthritic joint surfaces with a highly polished metal ball attached to a stem, along with a plastic socket. Patients who have bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement. These components have various sizes, and they are matched to your natural humerus head and shoulder socket. The metal ball and stem can be cemented or “press fit” into the bone. If the bone is of good quality and able to fully accept the stem, we may opt for the press fit method. If your bone is soft, however, we will place the stem with bone cement. In the majority of cases, the plastic socket (glenoid) is placed with bone cement. Not all patients need a plastic socket if:
- The socket has good remaining cartilage
- The glenoid bone is severely deficient
- The rotator cuff tendons are irreparably torn
If the patient still has a normal socket, but the head of the humerus is severely fractured, we may opt to replace just the ball. This is usually replaced with a metal ball and stem, similar to the part of total shoulder replacement. This may be a good choice when a patient has any of these traits:
- Arthritis that only involves the head of the humerus, with a socket that is still intact
- Shoulders with severely weakened bone in the socket
- Some shoulders with severely torn rotator cuff tendons and arthritis
This is the same as above, but the metal head is only a cap-like prosthesis without the stem pushed down into the humerus. This preserves natural bone. For younger patients or for very active patients this option avoids the risks of component wear and loosening that may occur with conventional head and stem replacements.
REVERSE TOTAL SHOULDER REPLACEMENT
In reverse total shoulder replacement, the components are flipped. The metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm. Reverse total shoulder replacement is used for people who have:
- Completely torn rotator cuffs with severe arm weakness
- The effects of severe arthritis and rotator cuff tearing
- A previous shoulder replacement that failed
For patients with these characteristics, conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle with conventional methods.
RECOVERY FROM SHOULDER REPLACEMENT SURGERY
These are major surgical procedures, and they will involve some pain at times, especially early on. You’ll have prescription pain medication and possible a pain pump in the hospital. We’ll start you on rehabilitation right away, usually on the day of your surgery, which surprises most people. It’s good to have you up and moving as soon as possible. You’ll stay in the hospital for 1-2 days. You will be discharged with your arm in a sling that you will wear for anywhere from 2-4 weeks.
You will have limited arm function for 6 weeks after your surgery. You need to be careful and not push things. You cannot lift any objects that weigh more than one pound. You must not push or pull anything.
Most patients can return to gentle daily activities within two to six weeks. You cannot drive for up to six weeks.
It’s important to follow and perform the regimen of home exercises your physical therapist gives you. If you do so, in about six months you can get back to more vigorous activities, such as swimming or golf.
WILL I HAVE RESTORED RANGE OF MOTION AFTER REPLACEMENT SURGERY?
Patients can regain close to full range of motion and full strength in their repaired shoulder. This can take up to one full year to attain, however.
HOW LONG WILL MY SHOULDER COMPONENTS LAST?
The components being used today are of the highest quality. It is estimated that shoulder replacements today will last at least 15-20 years.
RISKS OF HAVING SHOULDER REPLACEMENT SURGERY
During your consultations and preparation for surgery, your Orthopedic Associates of Long Island surgeon will explain all of the possible risks and complications of shoulder replacement surgery. These include both during the surgery and in the years after your procedure. Most of these can be successfully treated.
These are possible complications:
- Infection — Infection is a danger with any surgery. In shoulder joint replacement, infection may occur in the wound or deep around the prosthesis. It may happen immediately or years later. If the infection is major and deep, it may require more surgery to remove the prosthesis. Infections elsewhere in your body can spread to your new artificial joint.
- Prosthesis problems — Although materials used for today’s prostheses are state-of-the-art, they can still wear down and components may loosen. The new components of your shoulder replacement can even dislocate if the joint loosens enough or if there is trauma
- Nerve injury — It is possible to injure nerves in the vicinity of the joint replacement during surgery. This is very rare. If it does happen, these nerves will usually regenerate and heal.