Shoulder replacement surgery involves removing damaged parts of the shoulder bones and replacing them with prosthetic implants. Most people have less pain and greater mobility after surgery.
Each year, around 53,000 people in United States have shoulder replacement surgery to address persistent pain and lack of mobility in the shoulder.
This article explains what happens before, during, and after shoulder replacement surgery and what types are available. It also discusses who can benefit from surgery, the potential complications, and the effectiveness of surgery.
In shoulder replacement surgery, surgeons remove damaged parts of the shoulder and replace them with artificial parts, or prostheses.
Surgery aims to:
- reduce or resolve pain in the shoulder
- improve range of motion and mobility
- improve a person’s ability to perform everyday tasks
Doctors may recommend shoulder replacement surgery in the following situations:
- Shoulder pain prevents a person from performing essential everyday tasks.
- A person experiences moderate to severe pain while resting, which may affect their sleep quality.
- A person has lost mobility or experiences weakness in the shoulder.
- Other treatments, such as medications and physical adaptations, have not been effective at reducing pain.
Conditions affecting the shoulder
Several conditions can cause pain and stiffness in and around the shoulder. The following conditions
- Osteoarthritis (OA): OA is a degenerative joint disease in which the cartilage that cushions the shoulder bones breaks down, causing pain and stiffness.
- Rheumatoid arthritis (RA): RA is an autoimmune disorder that causes chronic inflammation in the joints, leading to cartilage damage.
- Complex fractures: When the head of the upper arm bone shatters, surgeons may have difficulty putting the pieces back together. Additionally, the bone pieces may not receive an adequate blood supply.
- Avascular necrosis, or osteonecrosis: This is a condition in which bone tissue dies from a lack of blood supply. The bone then collapses, leading to a loss of shape in the shoulder joint.
- Rotator cuff tear arthropathy: Long-standing rotator cuff tears can lead to arthritis and cartilage damage.
In rare cases, people may need revision surgery to correct a previous shoulder replacement. This may be because of implant loosening, dislocation, wear, or infection.
There are several types of shoulder replacement surgery. A healthcare team will assess a person’s needs before recommending one of the following procedures:
- Total shoulder replacement (TSR): People with bone-on-bone OA and intact rotator cuff tendons may be eligible for TSR. This surgery involves:
- replacing the head of the humerus, the upper arm bone, with a highly polished metal ball on a stem
- replacing the glenoid, or socket, with a plastic socket
- Shoulder hemiarthroplasty (SH): This surgery involves replacing only the humeral head with a ball-and-stem implant. Surgeons may recommend this procedure when the socket is intact but the humeral head is severely fractured.
- Reverse total shoulder replacement (RTSR): This procedure is suitable for people with completely torn rotator cuffs, arthritic damage, and severe arm weakness. The implant for an RTSR is reversed so the ball is attached to the shoulder bone and a plastic socket is attached to the arm bone. This allows a person to use the deltoid muscle to lift the arm rather than the torn rotator cuff.
Surgeons sometimes decide between procedures during surgery when they can fully assess the condition of the shoulder joint. People with OA may have better outcomes with TSR than with SH.
Doctors perform various exams before shoulder replacement surgery, which help determine a person’s fitness for surgery and the best surgical approach. These exams include:
- overview of medical history
- assessment of shoulder joint, muscle, and nerve function
- imaging tests such as:
Doctors advise people to optimize their health as much as possible before surgery. This may involve stopping smoking and drinking alcohol, losing weight if necessary, eating a nutritious diet, and exercising regularly.
People can prepare for surgery in the following ways:
- arranging transportation to and from the hospital
- planning who will help with everyday tasks during the recovery period
- not eating before the operation if doctors instruct this
- packing necessities for the hospital, such as hygiene products, money, and clothing
- maintaining optimal hygiene before the operation, including removing any nail polish or makeup
- An anesthesiologist sedates the person using anesthetic.
- The surgeon examines the shoulder’s range of motion. This is necessary because, without anesthetic, pain can sometimes give the illusion of a diminished range of motion.
- The surgeon begins making incisions to expose the shoulder.
- The surgeon removes the humeral head before preparing it for prosthetic implants. For TSR, the surgeon does the same for the glenoid.
- The surgeon attaches the necessary prosthetics using bone cement before fitting them together. Sometimes, they chooses press-fit humeral or glenoid prosthetics rather than cement if the bone is of good quality.
- The surgeon reconstructs the surrounding soft tissues.
People usually stay in the hospital for about 3 days after shoulder replacement surgery. Most people can get out of bed and eat solid food the day after surgery.
Doctors usually prescribe antibiotics to minimize the risk of infection. They may also prescribe pain medications or blood thinners to reduce the risk of blood clots.
After surgery, it is important not to overstrain the shoulder. A person will wear a sling on the affected arm for 2–6 weeks and cannot drive during that time.
The surgical team will place staples to hold the wound together, and a surgeon will remove these around 2 weeks after the procedure. A person should avoid soaking the wound until it has thoroughly sealed and dried.
Gentle exercises are essential during the recovery process. A surgeon or physical therapist will recommend an exercise regimen to help build flexibility and strength.
The surgeon will explain the possible risks and complications of the surgery, which include:
- damage to blood vessels or nerves
- shoulder instability
- shoulder stiffness
- tear of the rotator cuff tendon
- periprosthetic fractures, which are bone fractures around the implant
- loosening or dislocation of prosthetic components
- erosion of the glenoid
Shoulder replacement surgery aims to improve a person’s quality of life by reducing pain and improving range of motion, strength, and function.
The procedure’s effectiveness varies depending on the underlying condition.
According to studies cited in a
However, these percentages are based on small, older studies, and more research is necessary.
Doctors may recommend total or partial shoulder replacement surgery for people with severe pain and restricted mobility in the shoulder.
While the person is under anesthesia, surgeons remove damaged parts of the shoulder and replace them with prosthetic implants.
Recovery takes 2–6 weeks, and physical therapy is essential. Most people have reduced pain, a better range of motion, and improved quality of life after surgery.