Shoulder Arthroplasty FAQ

What is arthritis?
Why does my shoulder hurt?
What is total shoulder replacement?
What are the results of total shoulder replacement?
How long does the typical shoulder implant last?
What are the possible complications or risks of total shoulder replacement surgery?
What are the risks of shoulder replacement surgery?
Do implants fail, and can they be replaced?
Am I too old for total shoulder replacement surgery?
When should I have total shoulder replacement surgery?
What Should I Ask My Orthopedic Surgeon Before Shoulder Replacement Surgery?
How long and where will my incision be?
Will I need blood and can I donate my own blood?
Will I need to take a blood thinner?
What is the typical recovery period?
What is the best way to prepare for recovery?
What activities are acceptable after surgery and what activities should I avoid?
When will I be able to return to work?
How often will I need to be seen by my surgeon following this surgery?

 

What is arthritis?
There are more than 100 different kinds of arthritic conditions that can affect the human body. Osteoarthritis, or degenerative joint disease, is the most common form of arthritis. Osteoarthritis causes the cartilage to wear away, eventually resulting in painful bone-on-bone contact. Traumatic arthritis of the shoulder may be secondary to fractures or prior dislocations.

Why does my shoulder hurt?
The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What is total shoulder replacement?
Total shoulder replacement involves replacing the arthritic humeral head (ball) with a metal ball and resurfacing the glenoid (socket) with plastic. The subscapularis muscle, one of the four rotator cuff muscles, must be cut to expose the joint. This muscle is repaired at the end of surgery but must be protected while it heals. Surgery typically lasts two to three hours in routine cases.

What are the results of total shoulder replacement?
Results of total shoulder replacement have been shown to be excellent in the majority of patients. Outcomes will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, your activity level, your dedication to recovery, and your adherence to your surgeon's instructions.

How long does the typical shoulder implant last?
All implants have a limited life expectancy depending on an individual's age, weight, activity level, and medical condition(s). Many surgeons have reported that their patients can achieve good pain relief and motion for several years. However, a total joint implant's longevity will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon's recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time.

What are the possible complications or risks of total shoulder replacement surgery?
While uncommon, complications can occur during and after surgery. Some complications include, but are not limited to, infection, blood clots, nerve or vessel injury, implant breakage, mal-alignment, and premature wear, any of which can require additional surgery. To help avoid these complications, surgeons may prescribe antibiotics and blood thinners before and after surgery. Although implant surgery is extremely successful in most cases, some patients may experience pain and stiffness. Be sure to discuss these and other risks with your surgeon.

What are the risks of shoulder replacement surgery?
As always, risks of surgery include risks of general anesthesia which tend to be dependent on other medical issues you may have. Some specific risks of shoulder replacement surgery include:

  • Infection. Infection around an implanted joint is a very serious complication and therefore there are significant measures taken to avoid this complication. If an infection develops, the entire implanted joint may need to be removed in order to eradicate the infection.
  • Dislocation/Instability. Because of the ball-and-socket design of the implanted joint, it is important that the surgeon balance the soft-tissues around the shoulder to ensure it is not pulled out of position.
  • Loosening of the Implant. Over time, implanted joints may loosen. Developments are constantly being made to produce longer-lasting implanted joints, but this has not been perfected. If an implant loosens to the point where patients are having significant problems, a revision surgery may need to be performed (a replacement of a joint replacement).
  • Damage to Nerves or Blood Vessels. The shoulder is a tight space, and many important structures pass just next to the shoulder joint. The nerves that send and receive messages to and from your hand and arm, as well as the blood vessels that provide circulation, sit very close to the shoulder joint. One complication of this surgery is damage to a blood vessel or nerve.

Do implants fail, and can they be replaced?
Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in knee and hip replacements is implant loosening or implant wear that leads to loosening. In shoulders, then glenoid (socket) side is more prone to failure. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results. However, revised components have a slightly lower success rate.

Am I too old for total shoulder replacement surgery?
Age is not generally a concern if you are in reasonably good health and have the desire to continue living a productive, active life. However, you should see your personal physician to obtain an opinion about your general health and readiness for surgery. Patients in their seventies, eighties and nineties have had successful shoulder replacements.

If the rotator cuff is torn, you may need a special type implant to compensate for this to give you better motion, called a reverse shoulder arthroplasty.

When should I have total shoulder replacement surgery?
Your surgeon will evaluate your health history, perform a physical examination, and take X-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective. One exception to this may be advanced loss of glenoid bone.

What Should I Ask My Orthopedic Surgeon Before Shoulder Replacement Surgery?
If your doctor recommends joint replacement, it is normal to have many questions about the procedure. Below are some of the questions you may want to discuss with your orthopedic surgeon.

  • What are the risks and potential complications of shoulder replacement?
  • Do you do this procedure often?
  • How long will the procedure take?
  • How long will I be in the hospital?
  • When will I be able to resume normal activities?
  • How much pain relief or increased mobility can I expect?
  • Which type of implant have you chosen for my joint replacement?
     

How long and where will my incision be?
The incision is approximately five inches long, usually made on the front of the shoulder to gain access to the joint.

Will I need blood and can I donate my own blood?
Most patients do not require blood after surgery. It is possible that you may require blood, however.

Will I need to take a blood thinner?
The risk of a blood clot is minimal after total shoulder replacement. Routine use of strong blood thinners is not usually necessary. We recommend one aspirin a day for 2 weeks. Tell your doctor if you have a family history of blood clots.

What is the typical recovery period?
Most patients leave the hospital the next day. Pain medication is usually required for the first few weeks after surgery. Driving may be prohibited while on these medications. The postoperative pain should decrease each week and most patients are able to stop narcotic pain medication by three weeks. Over-the-counter medications may be recommended for occasional aches and pains.

What is the best way to prepare for recovery?
Proper preparation and a great attitude are the best ways to accomplish a more rapid recovery from joint replacement. With the help of a physical therapist or trainer, get yourself as physically fit before surgery as you can. Be prepared to continue with your exercise program after surgery. Proper nutrition, weight loss (if overweight), and an optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape.

If you have diabetes, you should have it under good control with a hemoglobin A1-C less than 7.0.

What activities are acceptable after surgery and what activities should I avoid?
Although total shoulder replacement is designed to restore motion and decrease pain, it does not return your shoulder to "normal". Like any mechanical device, it can wear out with use. Activities like heavy lifting or manual labor can cause early wear and failure of the shoulder implant. Many activities should not begin until the soft tissues around the shoulder heal, which can take three to six weeks. All postoperative activities should be cleared with your surgeon. Many patients can resume activities such as golf, doubles tennis, hunting, etc.

When will I be able to return to work?
Returning to work depends on your type of work. Return to work can be as early as two to six weeks for sedentary jobs. Returning to a job that requires significant use of the arm will usually take at least three months. Office workers often return in two to three weeks, while patients with more strenuous jobs may require more time away from work. The timing of your return to work depends considerably upon your commitment to recovery.

How often will I need to be seen by my surgeon following this surgery?
You will be scheduled to return to the doctor at 2, 6 and 12 and 24 weeks, then yearly. Visits may become less frequent, but it is important to have regular follow-up visits. At each visit, your surgeon may use X-rays to monitor any wear or loosening of the shoulder components.