Shoulder replacement surgery

If you have chronic shoulder pain due to arthritis or a traumatic injury, shoulder replacement surgery may be an option. Although it’s not as common as a knee or hip replacement, shoulder surgery is becoming more prevalent. More than 50,000 people in the U.S. have shoulder replacement surgery each year. With recent advances in joint replacement technology and technique, shoulder replacements are minimally invasive and are increasingly performed on an outpatient basis, meaning patients can recover at home the same day their surgery is performed.

What is shoulder replacement surgery?

Shoulder replacement surgery, also called shoulder arthroplasty, replaces a diseased or damaged shoulder joint with an artificial implant, otherwise known as a prosthesis. The ball and socket get replaced with metal and plastic parts to allow them to move smoothly in the joint. Depending on the extent of the damage, your surgeon may replace the ball, socket, or both.

When is shoulder replacement surgery recommended?

If non-surgical treatments such as pain management or physical therapy don’t alleviate your shoulder pain and interfere with your daily life, surgery may be your best bet. Your physician will refer you to an orthopedic surgeon who will evaluate your condition. They will review your medical history and assess your shoulder’s strength and stability. Various tests include X-rays, imaging scans, and blood work.

What causes shoulder pain?

There are many reasons why you may have shoulder problems. The degree of pain can vary depending on the type and severity of the injury. Common shoulder injuries that may require surgery include:

Osteoarthritis

Osteoarthritis is a degenerative joint disease affecting the cartilage in your shoulder joint. It’s the most common form of arthritis and develops gradually over time. As the cartilage that cushions and protects the shoulder joint wears down, you may experience symptoms like stiffness, pain, muscle weakness, limited range of motion, or a clicking sensation when you move your shoulder.

Bursitis

Your shoulder has small, fluid-filled sacs called bursae that cushion and lubricate your shoulder joint for unrestricted movement. Certain factors, such as repetitive motion, overuse, or trauma, can irritate the bursae. When the bursae become inflamed, the result is often pain, swelling, redness, and difficulty moving your shoulder. Your physician may be able to treat your shoulder bursitis with medications, therapy, or injections. However, if your symptoms persist or worsen, surgery could be an option.

Rheumatoid arthritis

This chronic autoimmune disorder attacks the membrane linings surrounding your shoulder joint. If the arthritis is severe enough that it has caused significant damage to the shoulder joint, your physician may recommend a shoulder replacement.

Rotator cuff injury

Rotator cuff injuries, common among athletes, are often caused by repetitive overhead motions or shoulder trauma. The rotator cuff muscles stabilize the shoulder joint and facilitate arm movement. When these muscles are torn or damaged, you may experience pain, inflammation, stiffness, and a popping sensation when you roll your shoulder. If conservative treatments don’t alleviate your symptoms, your physician may recommend arthroscopic repair or a shoulder replacement.

Shoulder fracture

Not all shoulder fractures require shoulder surgery. Depending on factors like your age, overall health, and the severity and location of the fracture, nonsurgical treatments can be effective. These treatments include physical therapy, pain medication, and immobilization. However, surgical intervention may be necessary if the damage is significant or disrupts blood flow to the shoulder.

Types of shoulder replacement surgeries

Your surgeon will work with you to determine the best and most minimally invasive course of action for treating your shoulder pain after evaluating your medical information and assessing all imaging and tests. If surgery is required, they may recommend a partial or total shoulder replacement, depending on the condition of your shoulder.

Total shoulder replacement

If a traumatic injury or degenerative condition has significantly damaged the shoulder joint, your surgeon may recommend a complete shoulder replacement. In this procedure, your surgical team will replace the ball and socket using durable, long-lasting artificial materials. These components are typically constructed of metal and plastic.

Partial shoulder replacement

This procedure, also called a shoulder hemiarthroplasty, involves replacing only the damaged portion of the shoulder joint. A hemiarthroplasty preserves some of the healthy bone, and is frequently considered as an option in younger, more active patients with healthy rotator cuff muscles.

Reverse shoulder replacement

This surgery is effective in treating cases where severe arthritis or irreparable rotator cuff tendons compromise the integrity of the shoulder joint. In a reverse procedure, the position of the ball and socket get reversed. That allows the deltoid muscle to power arm movement instead of the rotator cuff.

Double or bilateral shoulder replacement

Double or bilateral shoulder replacements, where both shoulders are replaced in separate or simultaneous surgeries, are relatively less common compared to single shoulder replacements. The decision to perform a bilateral shoulder replacement depends on various factors, including the extent of damage in both shoulders, the patient's overall health, and their ability to undergo the procedure and rehabilitation.

For patients with severe osteoarthritis or other shoulder conditions affecting both shoulders, bilateral shoulder replacement might be an option. Your doctor will evaluate the risks and benefits carefully, as the recovery and rehabilitation process can be more complex and challenging when both shoulders are involved.

Overall, while bilateral shoulder replacements are less common, they can be a viable option for certain patients who need significant improvement in both shoulders' function and quality of life.

Revision shoulder replacement

If you've undergone shoulder replacement surgery and are again experiencing pain or stiffness in the area around the joint, your doctor may recommend a revision surgery. They will study the area and take an MRI or X-ray, and if the implant has moved, worn out, or otherwise failed, or if an infection has set in, your doctor can surgically repair or replace the shoulder implant.

What are the risks of shoulder replacement surgery?

Generally, shoulder replacement surgery is considered safe. However, like most surgical procedures, there are potential risks.

What to expect after shoulder replacement surgery

You will be sedated during the replacement procedure, but may experience some pain and discomfort once the anesthesia wears off. Your care team will provide pain management strategies to alleviate your pain and speed up your recovery. Treatment methods may include anti-inflammatory medication, nerve blocks, and physical therapy.

How long does a shoulder replacement last?

Studies show that around 90% of shoulder replacements last 10 years or longer. Proper care and a healthy lifestyle could extend the life of your implant further.

Is it worth having shoulder replacement surgery?

If you have chronic shoulder pain that is interfering with your daily life, shoulder replacement surgery can improve your overall quality of life. Consult with your physician to help you determine the best course of action. Because the success rate for shoulder replacements is high, you may find the benefits outweigh any potential risks.