Are you considering shoulder replacement surgery? If
shoulder joint pain
is causing you to consider replacement surgery, you’ll want to understand all your options. What does shoulder replacement involve? What about reverse shoulder replacement? And, what kind of function can you expect after surgery? Learn more about this surgery from a physical therapist who knows.
The shoulder is technically comprised of a number of joints: the glenohumeral (GH) joint, the scapulothoracic (ST) joint, and the acromioclavicular (AC) joint. The specific joint that is involved with shoulder replacement is the glenohumeral joint. It is a ball and socked joint formed by the head of the humerus (arm bone) connecting with the glenoid of the scapula (shoulder blade).
The shoulder joint itself is not a very stable joint. The head of the humerus (ball portion) is much larger than the glenoid (socket). It is similar to a golf ball sitting on a golf tee. Fortunately the rotator cuff muscles of the shoulder provide dynamic stability for the joint.
Who Needs Shoulder Replacement Surgery?
Joint replacement surgery is generally performed secondary to arthritis. Both
can create joint damage significant enough to warrant joint replacement. Arthritis of the joint can occur when the thin cartilage that lines the end of the bones becomes damaged. Damage to this protective lining can allow the underlying bone to become damaged, leading to inflammation of the joint.
Shoulder replacement is less frequent than knee or
hip replacement surgery
because it is a non weight bearing joint. Weight bearing joints have a greater chance to develop arthritis secondary to the joint forces exacerbated by weight bearing. But, like the hip and knee, shoulder arthritis can develop. When
and functional limitation become so significant, shoulder replacement may be a viable option.
Like other arthritic conditions, previous injury or trauma can play a part in the development of arthritis. Injuries including shoulder dislocations and
rotator cuff tears
can allow for excessive mobility of the shoulder, increasing joint stress and leading to the development of arthritis.
Generally, people considering replacement surgery have had a long history of pain and limited function secondary to arthritis. Typical conservative treatment for arthritis includes anti-inflammatory medication,
steroid injections, and physical therapy. It is only when typical conservative treatment has failed, and significant pain and limited function continue, should shoulder replacement surgery be considered.
What is Shoulder Replacement Surgery?
Shoulder replacement involves removing the arthritic portions of the joint and replacing them with prosthesis. In the typical shoulder replacement both the ball (humeral head) and socket (glenoid) are replaced by metal or plastic components. Depending on the severity of arthritis, the doctor may choose not to replace the glenoid portion.
Generally the new head of the humerus is comprised of a composite metal. The glenoid portion is frequently made of a plastic material. Frequently cement is used in order to fixate the new prosthesis to the underlying bone.
A newer version of the shoulder replacement surgery is called a reverse shoulder replacement. In this surgery the head of the humerus is removed and instead of it being replaced by a new “ball” component, a socket is created. In turn, a new “ball” component is connected to the scapula. Thus the ball and socket construction is switched.
This surgery is specifically recommended for arthritic shoulders that also have limited or no rotator cuff function. This reverse construction makes it easier for the deltoid to stabilize the shoulder when the rotator cuff cannot.
What Are The Risks Of Surgery?
Shoulder replacement can be very successful in reducing arthritis symptoms. From a standpoint of pain reduction, shoulder replacement is generally successful.
Unfortunately, because the shoulder is an extremely mobile joint, regaining full range of motion should not be expected. The ability to actively abduct (raise the arm out to the side) is frequently limited following shoulder replacement. This reduction in range of motion can be quite limiting. Reverse shoulder replacements have a better chance of obtaining greater active mobility but because they are generally done when the rotator cuff is not functioning, reduced motion is still present.
In addition to a limitation in the range of motion, other risks are associated with this surgery. Of course the risk of infection, bleeding, and scars can result from surgery. In addition, in some cases, the replacement can fail if the prosthesis becomes lose. The shoulder can also dislocate if the shoulder is overstretched prior to healing.
What To Expect Following Surgery
Surgery for shoulder replacement generally involves a short (1-3 days) stay in the hospital. After surgery the use of pain medication is strongly encouraged. You will be given a sling to use and be unable to actively move the shoulder for up to six weeks. Applying ice frequently after surgery will be necessary in order to limit pain and swelling.
After being discharged from the hospital you will immediately begin physical therapy. During the first four to six weeks of physical therapy, range of motion is the focus. The physical therapist will passively move your shoulder through the range of motion. You will also be given home stretches to do. As regaining shoulder mobility is one of the most difficult aspects of recovery, being very consistent with the home range of motion exercises is important.
Generally by the sixth week of recovery you will be allowed to remove the sling and actively move the shoulder. The physical therapist will guide you with specific exercises to first regain active range of motion and then strength. The formal rehabilitation process can be up to twelve weeks with full recovery taking six to nine months.
• Shoulder replacement surgery is performed secondary to significant arthritis.
• Replacement surgery should only be considered when conservative treatment has failed.
• With replacement surgery the head of the humerus and sometimes the glenoid are replaced with a prosthesis.
• A reverse shoulder replacement is performed when the rotator cuff is not functioning and involves switching the ball and socked joint arrangement.
• Recovery from surgery involves six weeks of being unable to use the arm in addition to ongoing physical therapy.
Before deciding to undergo shoulder replacement surgery, consider all your options. Seek a second opinion and make sure your surgeon specializes in shoulder surgeries. Preparing yourself both before and after surgery will help to ensure that you have a positive surgical outcome.