What is Shoulder Replacement?

Shoulder pain can make simple tasks like combing your hair, reaching for a jar on a high shelf, or even getting a good night’s sleep feel like challenges. If you’re experiencing this kind of persistent discomfort, your doctor may have mentioned shoulder replacement surgery. But what is shoulder replacement? In this post, we’ll walk you through what you need to know about this procedure, from the anatomy of the shoulder to the different types of surgery and what to expect during recovery.

• Shoulder replacement surgery is a procedure to replace the damaged parts of the shoulder joint with artificial components.
• The most common reason for shoulder replacement is osteoarthritis, but it can also be used to treat other conditions like rheumatoid arthritis and severe fractures.
• There are two main types of shoulder replacement: anatomic total shoulder replacement and reverse total shoulder replacement.
• Recovery from shoulder replacement surgery is a gradual process that may involve physical therapy and activity modification.

Before we delve into the specifics of shoulder replacement, it’s helpful to understand the anatomy of the shoulder. The shoulder is a ball-and-socket joint, which is what allows for its incredible range of motion. The “ball” is the top of your upper arm bone (the humerus), called the humeral head. The “socket” is a shallow depression in your shoulder blade (the scapula) called the glenoid.

A smooth, slippery tissue called articular cartilage covers the surfaces of the ball and socket, allowing them to glide against each other with minimal friction. The joint is stabilized by a group of muscles and tendons called the rotator cuff. In addition to the rotator cuff, the deltoid muscle also plays a role in shoulder function. This large, powerful muscle covers the outer aspect of the shoulder and is responsible for lifting the arm away from the body.

Shoulder replacement surgery is typically recommended when the cartilage in the shoulder joint has worn away, causing the bones to rub against each other. This can lead to significant pain, stiffness, and loss of function.

Osteoarthritis is often described as “wear and tear” arthritis. Over years of use, the smooth articular cartilage can thin. This process is typically gradual, with pain and stiffness slowly increasing over time. Patients may notice that their range of motion is decreasing, and they may notice clicking or grinding when they move their shoulder. While the exact cause of osteoarthritis is not always clear, factors such as age, genetics, and previous joint stress can play a role.

Rheumatoid arthritis is an autoimmune disease. In this condition, the body’s immune system mistakenly attacks the synovium, the lining of the joint capsule. This leads to chronic inflammation, which can eventually destroy the articular cartilage and the underlying bone.

Post-traumatic arthritis can develop following a significant shoulder injury. For example, a severe fracture of the humerus or a recurrent dislocation can damage the articular cartilage. Even if the initial injury is treated successfully, the joint may be more susceptible to developing arthritis in the years that follow.

Avascular necrosis, also known as osteonecrosis, is a condition where the blood supply to the humeral head is disrupted. Without an adequate blood supply, the bone tissue begins to die and can eventually collapse. Avascular necrosis can be caused by several factors, including long-term steroid use, excessive alcohol consumption, or certain medical conditions.

Severe fractures of the shoulder can sometimes be so complex that they cannot be repaired with traditional plates and screws. In these cases, a shoulder replacement may be the recommended way to restore function and relieve pain. This is particularly true for older patients with poor bone quality.

Rotator cuff tear arthropathy is a specific type of arthritis that occurs in the presence of a large, long-standing rotator cuff tear. When the rotator cuff is no longer able to hold the humeral head centered in the glenoid socket, the humerus can migrate upward. This abnormal movement leads to increased wear on the cartilage and can cause a unique pattern of joint destruction.

Before recommending surgery, your doctor will likely suggest more conservative treatments. These may include:

• Physical therapy: A structured exercise program can help improve shoulder strength and flexibility, which may reduce pain and delay the need for surgery.
• Activity modification: Avoiding activities that aggravate the shoulder can help manage symptoms.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
• Corticosteroid injections: These injections can provide temporary relief from severe pain and inflammation.

However, if these treatments no longer provide adequate pain relief and your quality of life is significantly impacted, shoulder replacement may be the next step. The decision to proceed with surgery is a personal one, made in consultation with an experienced orthopedic surgeon.

There are two main types of shoulder replacement surgery: anatomic total shoulder replacement and reverse total shoulder replacement. The type of surgery your doctor recommends will depend on the condition of your shoulder joint and rotator cuff.

Anatomic total shoulder replacement, as the name suggests, aims to replicate the natural anatomy of the shoulder. In this procedure, the surgeon replaces the damaged humeral head with a metal ball and the glenoid socket with a plastic cup. This type of replacement is commonly recommended for patients with osteoarthritis who still have a functioning rotator cuff. The goal of anatomic total shoulder replacement is to relieve pain and restore motion, allowing patients to return to their normal daily activities.

The success of an anatomic total shoulder replacement relies heavily on the integrity of the rotator cuff muscles. These muscles are responsible for keeping the new metal ball centered within the plastic socket as the arm moves. If the rotator cuff is healthy and strong, the artificial joint may function similarly to a natural shoulder. Surgeons often use advanced imaging, such as CT scans or MRIs, to assess the condition of the rotator cuff and the quality of the bone before surgery.

Reverse total shoulder replacement is a procedure that is typically used for patients with a damaged or torn rotator cuff. In this surgery, the positions of the ball and socket are reversed. A metal ball is attached to the glenoid, and a plastic socket is placed on top of the humerus. This design allows the patient to use their deltoid muscle, instead of the rotator cuff, to lift their arm.

The concept of the reverse shoulder replacement was a major breakthrough in orthopedic surgery. Before its development, patients with both severe arthritis and a non-functioning rotator cuff had very limited options. Traditional anatomic replacements often failed in these patients because there was no rotator cuff to stabilize the joint. By reversing the anatomy, the center of rotation of the joint is shifted, which gives the deltoid muscle a mechanical advantage.

Once you and your surgeon have decided that shoulder replacement is the right option for you, there are several steps you can take to prepare for the procedure and ensure a smooth recovery. These may include:

• Medical evaluation: Your surgeon will likely order a series of tests, such as blood tests, an EKG, and a chest X-ray, to make sure you are healthy enough for surgery.
• Medication review: You will need to review your current medications with your surgeon. Some medications, such as blood thinners, may need to be paused before surgery.
• Home preparation: It’s a good idea to prepare your home for your return from the hospital. This may include arranging for help with daily tasks, preparing meals in advance, and removing any tripping hazards.
• Physical therapy: Your surgeon may recommend that you see a physical therapist before surgery to learn some exercises that will be helpful during your recovery.

Shoulder replacement surgery is typically performed under general anesthesia, meaning you will be asleep for the entire procedure. The surgery itself usually takes about two to three hours. After the surgery, you will be taken to a recovery room where you will be monitored closely as you wake up from the anesthesia. Your arm will likely be in a sling.

Some patients are able to return home the same day, while others stay in the hospital overnight. During this time, you will receive pain medication to keep you comfortable and may begin working with a physical therapist to learn some gentle range-of-motion exercises.

Recovery from shoulder replacement surgery is a gradual process that can take several months. It’s important to be patient with yourself and follow your surgeon’s instructions carefully. The recovery process is often divided into several phases, each with its own goals and restrictions.

In the first few weeks after surgery, the primary focus is on protecting the new joint and managing pain and swelling. You will likely need to wear a sling most of the time, including while you sleep. Your physical therapist will teach you some very gentle exercises, such as pendulum swings and passive range-of-motion movements, where the therapist or your other arm moves the surgical arm. These exercises help prevent stiffness without putting undue stress on the healing tissues.

As you move into the second phase of recovery, you will begin to gradually increase your activity level. You may be allowed to stop wearing the sling for part of the day and start doing more active range-of-motion exercises. This is when you begin to use your own muscles to move your arm. Your physical therapist may also introduce some light strengthening exercises, focusing on the muscles that support the shoulder joint.

In the third phase, the focus shifts to more intensive strengthening and functional activities. You will work on improving your ability to perform daily tasks, such as reaching into a cupboard or getting dressed. Your physical therapist will tailor your exercise program to your specific goals, whether that’s returning to a particular hobby or simply being able to perform household chores without pain.

It’s important to remember that everyone’s recovery is unique. Some patients may progress more quickly than others, and there may be occasional setbacks along the way. Maintaining a positive attitude and staying committed to your physical therapy program can be helpful for achieving the best possible outcome. Your surgical team will monitor your progress closely and make adjustments to your recovery plan as needed.

Shoulder replacement is a surgical procedure that aims to relieve pain and restore function in a damaged shoulder joint. Whether you are a candidate for an anatomic or reverse total shoulder replacement, the goal is the same: to help you get back to the activities you love without the burden of shoulder pain. If you are considering shoulder replacement surgery, your surgeon can review the risks and benefits to help determine if it is the right option for you.

Full recovery from shoulder replacement surgery can take up to a year or longer. However, many patients resume daily activities within a few months of the procedure.

Many patients return to low-impact sports such as golf, swimming, and tennis after shoulder replacement surgery. However, it is generally recommended to avoid high-impact activities and heavy lifting to protect the new joint. Your surgeon can provide specific instructions.

Before recommending surgery, your doctor may suggest more conservative treatments such as physical therapy, anti-inflammatory medications, and corticosteroid injections. In some cases, other surgical procedures, such as arthroscopy, may be an option.