What is shoulder replacement?
The shoulder joint is a ball and socket joint. Occasionally, the ball and socket can become worn and painful. When this occurs, your surgeon may recommend a shoulder replacement. In a shoulder replacement, the “ball” (humeral head) of the shoulder joint is replaced with a metal implant that has a stem with a smooth, rounded metal head. The “socket” (glenoid) may be replaced with a smooth, rounded plastic cup that fits the head of the ball perfectly. Depending on your condition, your surgeon may perform a total shoulder replacement in which both the ball and socket are replaced, or a partial shoulder replacement where only the ball is replaced.
Am I a candidate for shoulder replacement?
Shoulder replacement surgery may be an appropriate treatment for you if you have painful, limited arm and shoulder movement that makes you unable to perform everyday tasks comfortably or sleep well at night. Patients have usually had x-ray or MRI tests showing arthritis or other chronic problems, and find they are not getting the pain relief they need from medication, injections or physical therapy. Shoulder replacement may also be indicated for people who have suffered from shoulder fractures, or when the muscles that aid the shoulder’s movement (the rotator cuff) are torn or severely damaged. An orthopedic surgeon who specializes in shoulder surgery can best evaluate your condition and determine if a shoulder replacement is right for you.
What does the surgery involve?
Shoulder replacement surgery is performed in the hospital by an experienced, specialized surgical team. The procedure generally takes 1-3 hours, although this varies depending on the circumstances. An incision about 4-8 inches long is made in the front of the shoulder, and the humeral head (ball) is removed and the remaining bone is prepared to receive the implant. The new ball and stem component is then inserted into the bone. If a total shoulder replacement is being performed, the socket side of the joint is then smoothed and prepared, and the new plastic socket component is attached securely into place. The new ball and socket are joined together, and the incision is closed.
What is shoulder resurfacing?
Some patients may be candidates for shoulder resurfacing. With shoulder resurfacing, the patient’s damaged humeral head is not removed, but instead is sculpted to receive a metal “cap” that fits on the end of the bone. This cap functions as a smooth humeral head. This procedure can be less invasive than total shoulder replacement and can provide pain relief; however, your surgeon will advise the best option for your specific condition.
What is a “reversed” shoulder replacement?
When shoulder arthritis occurs in patients with torn rotator cuff muscles, a procedure known as a reversed shoulder replacement may be recommended. It is called a reversed replacement because it reverses the normal structure of the shoulder joint. With this procedure, the ball and socket configuration is reversed: The ball portion of the implant is attached to the glenoid (where the socket normally is), and the artificial socket is attached to the humeral head (where the ball normally is), in the form of a plastic cup. This configuration allows the stronger deltoid muscles of the shoulder to take over much of the work of moving the shoulder, increasing joint stability.
Why haven’t I heard much about shoulder replacement?
Many people know of someone who has found pain relief from hip or knee replacement, but few know someone who has had a shoulder replacement. It is true that shoulder replacement is not as common as hip and knee replacement, but the procedure is just as reliable and successful in relieving pain and restoring mobility.*
* Source: PearlDiver Analyst, public sources and PearlDiver Patient Record Database, 2004-2006.
Who can perform this procedure?
As with any surgical procedure, experience matters. Shoulder replacement is a complex procedure, and is best performed by an orthopedic surgeon who specializes in shoulder surgery, and not just knee and hip replacement. During residency training, most surgeons perform over 250 hip and knee replacements. However, some surgeons, during their residency training, may never see a shoulder replacement. Most surgeons wishing to specialize in shoulder reconstruction proceed to additional fellowship training following completion of their residency program.
How long will I be in the hospital?
Shoulder replacement surgery is performed on an in-patient basis and generally involves a hospital stay of 1-3 days; however, the length of the hospital stay can depend on many other factors. Your surgeon will advise you on what he/she believes is likely for your specific situation.
Will insurance cover it?
Shoulder replacement surgery is covered by Medicare and Medicaid as well as most private insurance companies. Contact your insurance provider to determine coverage under your specific plan.
Am I too young to have shoulder replacement surgery?
An orthopedic specialist who is experienced in shoulder replacement surgery can evaluate your particular situation and determine whether you are a candidate for the procedure. The performance of a prosthetic joint and how long it will last depends on many factors, including the type of implant used, your physical condition, bone quality, activity level and lifestyle. Patients younger than age 50 frequently undergo replacement of only the humeral head (ball). These younger, more active, individuals have greater risk of loosening the glenoid (socket) implant over time. Replacement of the ball is still effective at providing pain relief in these young, active patients.
Will my shoulder appear normal after the surgery?
Most patients do not experience a dramatic change in the appearance of their shoulder or the natural contour of the shoulder. However, there will likely be a visible scar on the front of the shoulder from the incision.
Are there any interactions to consider with current medications I’m taking?
Talk with your doctor about any medications that you are currently taking. You will be advised if you need to make any changes in your medication schedule. Prednisone and other steroids can cause delayed healing after surgery. Make sure your surgeon is aware of any steroid medication you may be taking, even if they are inhalers. Generally, patients are advised to stop taking prescription or over the counter anti-inflammatory medication, including aspirin or ibuprofen five days before surgery. These medications thin the blood and can lead to excessive bleeding during surgery.