Am I too young for shoulder replacement surgery?
Patients younger than age 50 frequently undergo hemiarthroplasty: replacement of only the humeral head (ball). Younger, more active people run a greater risk of loosening the glenoid (socket) implant over time. Replacement of the ball is still effective at providing pain relief for young, active patients.
What are the risks involved?
Shoulder replacement surgery has been performed successfully since the 1950s. Nevertheless, there are certain risks involved as with any surgical procedure:
Infection – infection is a complication of any surgery. In shoulder joint replacement, infection can start in the wound or deep around the implant. It may happen in the hospital or after you go home. It may even occur years later. It may even start in another part of the body and spread to the shoulder. Minor infections are generally treated with antibiotics. Serious infections may require more surgery and removal of the implant.
Nerve injury – nerves around the joint replacement may become damaged during surgery, although this type of injury is very rare. Over time, nerve injuries often improve and may completely recover.
Instability and loosening of the implant – while technology continues to improve the techniques and materials used in shoulder replacement, the implant may wear down and the components begin to loosen. Excessive wear, loosening or dislocation could need further corrective surgery.
These risks are rare; most patients experience relief from pain and increased mobility of the shoulder after surgery.
Tips to ensure your surgery is a success
Success post-surgery will depend largely on how well you follow your orthopedic surgeon’s instructions at home during the first few weeks after surgery. Some common guidelines include:
Don’t use the affected arm to push yourself up in bed or from a chair.
Don’t overdo things! Don’t be tempted to over-use your shoulder too early on.
Don’t lift anything heavier than a glass of water for 2-4 weeks post-surgery.
Do follow the program of exercises prescribed for you.
Do ask for help when you need it! Contact your medical team for advice if you don’t have sufficient backup at home.
Shoulder Arthritis - Total Shoulder Replacement
Are you ready for a new shoulder? - Shoulder Replacement Surgery
In 2012, over 50,000 shoulder replacement surgeries were carried out in the USA. Is it time to get your life back? Is shoulder replacement a realistic option for you?
By Lisa Sanders
What is shoulder replacement surgery?
The shoulder is a ball and socket joint. It’s designed to rotate through a greater range of motion than any other joint in the body. But when that joint becomes worn it is extremely painful, leading to loss of movement in the arm and shoulder. If you can’t lift your arm, perform everyday tasks or sleep at night, your doctor may recommend arthroplasty, the medical name for a shoulder replacement operation.
Under anesthetic, an orthopedic surgeon replaces the “ball” or humeral head of the shoulder joint with a metal implant. The “socket” or glenoid is replaced by a smooth, rounded plastic cup that perfectly fits the ball. The surgeon may decide on a full or partial replacement, depending on your condition. In reverse shoulder replacement, the socket and ball are switched. A metal ball is attached to the shoulder bone and a plastic socket is fixed to the upper arm bone.
While shoulder replacements are less common than hip or knee replacements, they have been proven to be just as effective in relieving joint pain. Most patients find that after surgery, they can move freely again and live life normally.
Symptoms and causes for shoulder replacement surgery
If you suffer from rheumatoid arthritis osteoarthritis or inflammatory arthritis in your shoulder, you may be finding some basic daily tasks difficult. Simple things like reaching into a cupboard, getting dressed or showering, become a constant battle. Similarly if you’ve suffered a shoulder fracture or torn or damaged the muscles that help the shoulder to move (these are called the rotator cuff muscles) you may have found that non-surgical measures such as physical therapy, anti-inflammatory drugs and cortisone injections aren’t helping. Many sufferers complain of pain, stiffness and swelling which doesn’t go away even when they are not moving, which prevents a good night’s sleep. If this sounds familiar, you may want to consider shoulder replacement surgery.
Before you decide whether to have shoulder replacement surgery, talk it over thoroughly with your family, your doctor and your orthopedic surgeon.
What does the Surgery Involve?
Shoulder replacement surgery is carried out in the hospital by an experienced, specialized surgical team. The surgeon removes the damaged parts of the shoulder and replaces them with artificial parts. The surgeon can replace either just the head of the humerus bone, the ball, or replace both the ball and the socket, the glenoid.
“Before you decide to go for replacement surgery,
talk it over thoroughly with your family, your doctor
and your orthopedic surgeon”
The surgery normally takes 1-3 hours. It is usually carried out under general anesthetic. An incision is made in the front of the shoulder, and the humeral head (the ball) is removed. The new ball and stem are then inserted into the bone. If the surgeon is carrying out a total shoulder replacement, the socket side of the joint is then smoothed and the new plastic socket is attached securely in place.
Shoulder replacement materials are technologically advanced, and are identical to the materials used in knee and hip replacements. The ball and stem are made from titanium and cobalt chrome metals; the socket is made of plastic called polythene.
Which Surgery is right for me?
The surgeon will discuss with you which type of replacement surgery is best suited to you. You should always ask what type of treatment will be used, and why that choice is right for you.
If the humeral head (the ball) is severely fractured but the socket is normal, with healthy and intact cartilage, your surgeon may recommend replacing only the ball. This procedure is called hemiarthroplasty. Sometimes, surgeons make the decision between a total shoulder replacement and a hemiarthroplasty in the operating room at the time of the surgery. Studies have shown that patients with osteoarthritis get better pain relief from total shoulder replacement than from hemiarthroplasty.
Alternatively, particularly if you are young or very active, you might be offered shoulder resurfacing. In this surgery, the damaged humeral bone is not removed, but instead is sculpted and a metal cap is fitted onto the end of the bone. This is a less invasive operation than total shoulder replacement and has the advantage of preserving the humeral bone.
“Shoulder replacement has been proven to
reduce pain and improve mobility, but results
vary from patient to patient”
A fourth type of shoulder replacement is called reverse total shoulder replacement. It’s called reverse shoulder replacement because it reverses the normal structure of the shoulder joint: the ball part of the implant is attached to the place where the socket is normally, in the form of a plastic cup-shaped structure. The surgeon will recommend reverse shoulder replacement for people whose shoulder muscles, the rotator cuffs, have torn completely, often due to arthritis, leading to severe arm weakness. In this scenario, a conventional shoulder replacement can be ineffective, resulting in lasting pain and being unable to raise the arm past a 90-degree angle. Reverse shoulder replacement works by making the shoulder’s stronger deltoid muscles take over much of the function of moving the shoulder, increasing stability of the joint.
Recovery from surgery
Once the anesthetic wears off you’ll start to feel pretty sore; the surgeons and nurses will give painkillers to make you feel as comfortable as possible. You will also receive several doses of antibiotics to prevent infection. Generally you will have to stay in hospital for 1-3 days after the surgery.
Most patients are able to eat solid food and get out of bed the day after surgery. You will have staples running along your wound or a suture beneath your skin. The staples will be taken out a few weeks after surgery. A suture beneath your skin will not need to be removed.
When you leave hospital your arm will be in a sling. You will need to support your arm and protect your shoulder with the sling for the first weeks after surgery. You will not be allowed to drive for 2 to 4 weeks after surgery.
Aftercare and success rate
When you come home from the hospital, you’ll need help for a few weeks with some daily tasks like getting dressed, bathing and cooking.
Physical therapy begins soon after surgery, and exercise is a key part of ensuring the success of the operation. Your surgical team will set out an exercise plan. Most patients are able to get back to simple tasks such as eating and getting dressed within two weeks after their surgery. Some pain is common for several weeks afterwards.
You will have a visible scar from the surgery but otherwise your shoulder should look completely normal. Studies have shown 93% of patients have their implants 10 years after surgery, and 87% have theirs after 15 years. 83% of patients report moderate or severe pain relief 12 years following surgery. Shoulder replacement has been proven to reduce pain and improve mobility, but results vary from patient to patient.