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Shoulder replacement

Definition

Shoulder replacement is surgery to replace the bones of the shoulder joint with artificial joint parts.

Alternative Names

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

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 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 drain in this area to carry out fluid that may build up in the joint. The drain will be removed when you no longer need it.

This surgery usually takes 1 to 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 for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risk for 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

Always tell your doctor or nurse what drugs you are taking, even drugs, 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 drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs 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.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs 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.

After the Procedure

You may stay in the hospital for 1 to 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.

Outlook (Prognosis)

Shoulder replacement surgery relieves pain and stiffness for most people. You should be able to do most of 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, most people’s new shoulders last for at least 10 years.

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: Mosby Elsevier; 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: Mosby Elsevier; 2007:chap 299.

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