Shoulder replacement

Description

You will receive anesthesia before this surgery. Two types of anesthesia can be used:

• General anesthesia, which means you will be unconscious and unable to feel pain.
• Regional anesthesia to numb your arm and shoulder area so that you do not feel any pain in this area. If you receive regional anesthesia, you will also be given medicine to help you relax during the operation.

The shoulder is a ball and socket joint. The round end of the arm bone fits into the opening at the end of the shoulder blade, called the socket. This type of joint allows you to move your arm in most directions.

For total shoulder replacement, the round end of your arm bone will be replaced with an artificial stem that has a rounded metal head. The socket part (glenoid) of your shoulder blade will be replaced with a smooth plastic shell (lining) that will be held in place with a special cement. If only 1 of these 2 bones needs to be replaced, the surgery is called a partial shoulder replacement, or a hemiarthroplasty.

For shoulder joint replacement, your surgeon will make an incision (cut) over your shoulder joint to open up the area. Then your surgeon will:

• Remove the head (top) of your upper arm bone (humerus)
• Cement the new metal head and stem into place
• Smooth the surface of the old socket and cement the new one in place
• Close your incision with staples or sutures
• Place a dressing (bandage) over your wound

Your surgeon may place a tube in this area to drain fluid that may build up in the joint. The drain will be removed when you no longer need it.

This surgery usually takes 1 - 3 hours.

Why the Procedure is Performed

Shoulder replacement surgery is usually done when you have severe pain in the shoulder area, which limits your ability to move your arm. Causes of shoulder pain include:

• Osteoarthritis
• Poor result from a previous shoulder surgery
• Rheumatoid arthritis
• Badly broken bone in the arm near the shoulder
• Badly damaged or torn tissues in the shoulder
• Tumor in or around the shoulder

Your doctor may not recommend this surgery if you have:

• History of infection, which can spread to the replaced joint
• Severe mental dysfunction
• Unhealthy skin around the shoulder area
• Very weak (rotator cuff) muscles around the shoulder that cannot be fixed during surgery

Risks

Risks of any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risk of any surgery are:

• Bleeding
• Blood clot
• Infection

Risks of shoulder replacement surgery are:

• Allergic reaction to the artificial joint
• Blood vessel damage during surgery
• Bone break during surgery
• Nerve damage during surgery
• Dislocation of the artificial joint
• Loosening of the implant over time

Before the Procedure

Tell your doctor or nurse what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

• Two weeks before surgery you may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve).
• Ask your doctor which medicines you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
• Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing.
• Let your doctor know right away if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.

On the day of your surgery:

• You will likely be asked not to drink or eat anything for 6 - 12 hours before the procedure.
• Take the medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

• You may stay in the hospital for 1 - 3 days after your surgery.
• While there, you may receive physical therapy to help keep the muscles around your shoulder from getting stiff.
• Before you go home, the physical therapist will teach you how to move your arm around by using your other (good) arm to help.
• Your arm will need to be in a sling for 2 - 6 weeks with no active movement and 3 months before strengthening. It will be around 4 - 6 months of recovery.
• Follow any instructions you are given about how to care for your shoulder at home. This includes activities that you should not do.
• You will be given instructions on shoulder exercises to do at home. Follow these instructions exactly. Doing the exercises in a wrong way can injure your new shoulder.

Outlook (Prognosis)

Shoulder replacement surgery relieves pain and stiffness for most people. You should be able to resume your normal daily activities without much problem. Many people are able to return to sports such as golf, swimming, gardening, bowling, and others.

Your new shoulder joint will last longer if less stress is placed on it. With normal use, a new shoulder joint can last for at least 10 years.

Alternative Names

Total shoulder arthroplasty; Endoprosthetic shoulder replacement; Partial shoulder replacement; Partial shoulder arthroplasty; Replacement - shoulder; Arthroplasty - shoulder

References

Azar FM, Calandruccio JH. Arthroplasty of the shoulder and elbow. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 8.

Goldberg VM, Kraay MJ. Surgical treatment of joint diseases. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 299.

Izquierdo R, Voloshin I, Edwards S, et al. Treatment of glenohumeral osteoarthritis. J Am Acad Orthop Surg. 2010;18(6):375-82.

Update Date: 11/15/2012

Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.