When is Total Shoulder Replacement Necessary?
Total shoulder replacement (also called total shoulder arthroplasty) is a surgical solution for shoulder pain that involves replacing arthritic joint surfaces and damaged bone with artificial devices.
One common reason for a shoulder replacement is shoulder arthritis. Severe degenerative arthritis, or osteoarthritis, happens when the cartilage has worn away. The smooth surfaces of the head of the humerus (ball) and glenoid (socket) become rough, and they rub against each other rather than glide.
Another common reason for a shoulder replacement is a fracture involving the shoulder joint. Less common reasons for shoulder replacements include inflammatory arthritis/rheumatoid arthritis, where the cartilage is destroyed by the inflammation. Avascular necrosis is another cause, where there is a loss of blood supply to the humeral head (ball).
Shoulder Replacement Surgery FAQ
Is shoulder replacement a “last resort” for my chronic pain?
No, this is an outdated concept. Recent studies show that shoulder replacement is simpler, more convenient, and has better outcomes than hip or knee replacement procedures, although these are far more common.
Researchers at Johns Hopkins, for example, reported: “… patients who undergo shoulder arthroplasty to relieve chronic and significant pain can expect significantly fewer complications, much shorter hospital stays, and less costs than patients undergoing hip or knee replacement.”
If you are experiencing chronic shoulder pain as a result of arthritis or injury, there is no reason to rely on medications and reduced activities to make the pain tolerable. Experienced Chicago orthopaedic surgeon Dr. Anthony Romeo will help you explore the benefits of this effective surgical procedure.
Can I undergo the procedure with a damaged rotator cuff?
For a traditional shoulder replacement to be successful, the rotator cuff must be in a functioning state. The rotator cuff is comprised of muscles and their tendons that join the shoulder blade with the shoulder. If the tendons have become separated from the shoulder and/or shoulder blade, the standard shoulder replacement technique is not advised. Instead, Dr. Romeo may recommend a reverse shoulder replacement to improve or fully restore motion and function to the shoulder.
Is shoulder replacement a permanent solution to pain and lost functionality?
The typical implanted prosthesis lasts 15+ years. During this time, you can expect to enjoy an active lifestyle. Most patients report a substantial reduction or complete elimination of pain. If you are physically active, you may experience the occasional ache, but the difference from the period before shoulder replacement will be dramatic.
During physical therapy after surgery, you will start to see real improvements in the function and flexibility of your shoulder joint. Patients of Dr. Romeo reclaim significant range of motion after shoulder replacement. Some of the success of the surgery depends on whether a rotator cuff was damaged prior to the procedure and how long a patient has been living with limited shoulder movement.
Total Shoulder Replacement Surgery Details
The essential part of the surgery is to remove the damaged area and replace it with a shoulder prosthesis (artificial joint). To get to the shoulder joint, an incision is made on the front of your shoulder. After exposing the shoulder joint, the damaged ends of the bone are removed.
Then the bone is prepared for the placement of the artificial joint. The artificial joint is made of metal—usually a titanium or a cobalt-chrome alloy. The stem is placed inside the humerus bone and bone cement may be used to secure it.
Some patients benefit from a glenoid component, made of a special plastic, also being added during surgery. The final decision to use a glenoid component is made during the surgery. Patients with osteoarthritis and inflammatory arthritis generally benefit from the placement of a glenoid component.
After all the components are in place, the shoulder joint is checked to make sure that the shoulder is stable and has the potential for good motion after rehabilitation.
Shoulder Replacement Recovery
Shoulder replacement surgery can be performed in-patient or outpatient, depending on the patient’s overall health and needs. If your surgery is done on an inpatient basis, you will likely stay in the hospital for one night. If you have it on an outpatient basis, you will go home the same day.
After surgery, you will return home wearing a brace that will keep your shoulder immobile, allowing it to heal quickly and efficiently. You may be given a pump that will allow you to calibrate your pain medication, but in one to two days you will begin taking the medicine orally. Additional pain relief can be attained by the regular application of ice packs. Antibiotics will also be prescribed to prevent infection. Dr. Romeo will provide specific instructions to manage any post-op pain.
The progression of your recovery depends on how quickly the bone joins with the base plate and screws that have been surgically implanted, and whether a bone graft was part of the procedure. Bone grafts may be used if the condition of the socket bone makes it difficult to attach the prosthesis with screws.
From the early days of your recovery, physical therapy will be important. Moving the wrist, elbow and fingers, together with some cautious light exercise of the shoulder, is key to ensuring the shoulder heals efficiently and you gain maximum range of motion and functionality. You will be able to use your arm for simple tasks in a few days and the shoulder will regain normal function in several weeks. Expect not to drive for at least a month.
For more information about relieving shoulder pain and restoring motion with shoulder replacement surgery, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call our office today to schedule your visit.
Anatomy of the Shoulder as it relates to Surgery
Shoulder Replacement Surgery Video
Total Shoulder Replacement Video Animation
Reid W., Total Shoulder Replacement
Todd L., Total Shoulder Replacement
Additional Shoulder Replacement Surgery Links
Want to know more? Here’s some of Dr. Romeo’s recent medical journal articles about shoulder arthroplasty:
- Managing Glenoid Deformity in Shoulder Arthroplasty: Role of New Technology (Computer-Assisted Navigation and Patient-Specific Instrumentation
- Outpatient vs. inpatient reverse total shoulder arthroplasty: outcomes and complications
- Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature
- Construct validation of machine learning in the prediction of short-term postoperative complications following total shoulder arthroplasty
- Single Assessment Numeric Evaluation (SANE) is shoulder arthroplasty
- Inferior outcomes and higher complication rates after shoulder arthroplasty in workers’ compensation patients
- Single Assessment Numeric Evaluation is a Reliable Metric to Predict Clinically Significant Improvements Following Shoulder Arthroplasty
- Augmented glenoid implants in anatomic total shoulder arthroplasty: review of available implants and current literature
- Comparative Utilization of Reverse and Anatomic Total Shoulder Arthroplasty: A Comprehensive Analysis of a High-volume Center
- Shoulder Arthroplasty Outcomes After Prior Non-Arthroplasty Shoulder Surgery
- Reasons for Readmission Following Primary Total Shoulder Arthroplasty
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.