Surgery Overview

Joint replacement involves surgery to replace the ends of bones in a damaged joint. This surgery creates new joint surfaces.

In shoulder replacement surgery, doctors replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement. Or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement.

The top end of your upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone, that has a rounded head. If the cup-shaped surface of your shoulder bone that cradles your upper arm bone is also damaged, doctors smooth it. Then they cap it with a plastic or metal and plastic piece.

In some cases, surgeons do a reverse total shoulder replacement. It's for people who have painful arthritis in their shoulder and also have damage to the muscles around the shoulder. In this procedure, the surgeon removes the damaged bone and smooths the ends. Then the surgeon attaches the rounded joint piece to the shoulder bone. The cup-shaped piece is used to replace the top of the upper arm bone.

Doctors often use general anesthesia for joint replacement surgeries. This means you'll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can't feel the area of the surgery and you are sleepy, but you are awake. The choice of anesthesia depends on your doctor, on your overall health, and, to some degree, on what you prefer.

Your doctor will let you know if you will stay in the hospital or if you can go home the day of surgery. Some people stay in the hospital 1 or 2 days.

If you need any major dental work, your doctor may recommend that you have it done before the surgery. Infections can spread from other parts of the body, such as the mouth, to the artificial joint and cause a serious problem.

What To Expect

After surgery

You might get intravenous (I.V.) antibiotics for about a day after surgery. You will also receive medicines to control pain, and you might get medicines to prevent blood clots. It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you don't feel well.

When you wake up from surgery, you will have a bandage on your shoulder. And you'll probably have a drain to collect fluid and keep it from building up around your joint. You may also have a compression sleeve on your arm or legs. This sleeve squeezes your arm or legs to help prevent blood clots. You may keep taking medicines to prevent blood clots for several weeks after surgery.

In the hospital

A physiotherapist may begin gentle exercises of your shoulder on the day of surgery or the day after. These exercises are just passive motion. This means you relax and let the therapist move your arm for you.

The therapist will show you what exercises to do at home.

Most people who have shoulder replacement surgery are able to sit up and get out of bed with some help later on the day of surgery.

Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced.

Rehabilitation (rehab) after a shoulder replacement starts right away. It's not too demanding early on, but it is very important that you do it. To get the most benefit from your shoulder replacement, take part in physiotherapy both while you are in the hospital and at home.

Some people stay in the hospital 1 or 2 days.

Your recovery

After you go home, watch the surgery site and your general health. If you notice any redness or drainage from the wound, tell your surgeon. You may also be advised to take your temperature twice each day and to let your surgeon know if you have a fever.

You will have an exercise program to follow when you go home, even if you are still having physiotherapy. Do the exercises as your physiotherapist taught you. Staying on your exercise program will help speed your recovery.

Rehab typically continues after you leave the hospital until you are able to function more independently and you have recovered as much strength, endurance, and mobility in your shoulder as you can. Total rehab after surgery will take several months.

As your rehab continues, you will slowly be able to do more over a period of several weeks.

The main goal of rehab is to allow you to move your shoulder as far as possible so it's easier for you to do daily activities, such as dressing, cooking, and driving. Most people eventually regain about two-thirds of normal shoulder motion after surgery. But other things that affect how much movement you get back after surgery are how much movement you had before surgery and whether the soft tissues around your shoulder were also damaged. It is very important that you take part in physiotherapy both while you are in the hospital and after you are released from the hospital to get the most benefit from your surgery.

Living with a shoulder replacement

Your doctor may want to see you from time to time for several months or more to monitor your shoulder replacement. Over time, you will return to many of your pre-surgery activities.

Stay active to help keep your strength, flexibility, and endurance. Your activities might include light yard work, walking, swimming (after your wound is completely healed and your doctor has approved), dancing, and golf. Your doctor may recommend that you avoid heavy lifting and repetitive activities.

In the future, make sure to let all health professionals know about your artificial shoulder so they will know how to care for you.

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Why It Is Done

Doctors recommend joint replacement surgery when shoulder pain and loss of function become severe and when medicines and other treatments no longer relieve pain. Your doctor will use X-rays to look at the bones and cartilage in your shoulder to see whether they are damaged and to make sure that the pain isn't coming from somewhere else.

Shoulder replacement may not be recommended for people who:

• Have poor general health and may not tolerate anesthesia and surgery well.
• Have an active infection or are at risk for infection.
• Have osteoporosis (significant thinning of the bones).
• Have severe weakness of or damage to the muscles around the shoulder.

Some doctors will recommend other types of surgery if possible for younger people and especially for those who do strenuous work. A younger or more active person is more likely than an older or less active person to have an artificial shoulder joint wear out.

Doctors usually do not recommend shoulder replacement surgery for people who have very high expectations for how much they will be able to do with the artificial joint (for example, people who expect to be able to play competitive tennis, paint ceilings, or do other activities that stress the shoulder joint). The artificial shoulder allows a person to do ordinary daily activities with less pain. It does not restore the same level of function that the person had before the damage to the shoulder joint began.

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How Well It Works

Most people have much less pain after shoulder replacement surgery and are able to do many of their daily activities more easily.

• The shoulder will not move as far as it did before you started having shoulder problems. But the surgery will allow you to do more of your normal activities without pain.
• After surgery, you may be allowed to resume activities such as golfing, riding a bike, swimming, walking for exercise, dancing, or cross-country skiing (if you did these activities before).
• Your doctor may discourage you from doing things that put a lot of stress on the joint.

The younger you are when you have the surgery, and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.

Your artificial joint should last longer if you do not do hard physical work or play sports that stress the joint. Shoulder replacements usually last for about 10 to 20 years.

Risks

The risks of shoulder replacement surgery include:

Blood clots.

People can develop a blood clot in a leg vein after shoulder joint replacement surgery but usually only if they are inactive. Blood clots can be dangerous if they block blood flow from the leg back to the heart or move to the lungs.

Infection in the surgical wound or in the joint.

Infection is rare in people who are otherwise healthy. People who have other health problems, such as diabetes, rheumatoid arthritis, or chronic liver disease, and those who take corticosteroids are at higher risk of infection after any surgery.

Nerve injury.

In rare cases, a nerve may be injured around the site of the surgery. It is more common (but still unusual) if the surgeon also fixes deformities in the joint. These injuries usually get better over time and in some cases may go away completely.

Problems with wound healing.

These problems are more common in people who take corticosteroids or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes.

Lack of good range of motion.

Some people can't move their shoulder far enough to allow them to do their regular daily activities, even after several weeks of recovery. How far you can move your shoulder after surgery depends a lot on how far you could move it before surgery. If this happens, the doctor may give you a medicine to relax your muscles and will gently force the shoulder to move farther.

Dislocation of the upper arm bone (humerus).

This usually only happens if the soft tissues around the shoulder are stretched too soon after surgery. To help prevent dislocation, do not allow your elbow to move past your body toward your back.

Fracture of the upper arm bone.

This is an unusual complication, but it may happen either during or after surgery.

Instability in the joint.

This can be the result of either the soft tissues being stretched too soon after surgery, or the new joint pieces loosening.

The usual risks of general anesthesia.

Risks of any surgery are higher in people who have had a recent heart attack and those who have long-term (chronic) lung, liver, kidney, or heart disease.