The shoulder has more range of motion than any other joint, making it more prone to instability. You may experience severe shoulder pain while performing everyday activities or even feel pain while the shoulder is resting. If your shoulder is weak and less mobile, you may try anti-inflammatory medications, injection, and physical therapy and feel as though you may never have the relief you crave. Fortunately, the damaged areas of your shoulder can be removed and replaced with prosthesis so you can get back to living a normal life.
Although shoulder joint replacement is not as common as knee or hip replacement surgery, it is just as successful in treating many painful conditions. Shoulder joint replacement surgery is considered when nonsurgical methods fail to bring long-term pain relief. There are many different types of shoulder replacements that patients and doctors can choose, depending on which would benefit the most. Generally, total shoulder replacement surgery involves exchanging the damaged joint surfaces with a medical grade metal ball attached to a stem and a plastic socket. Depending on the damage, the doctor may only replace the ball joint. Another kind of shoulder replacement is called reverse total shoulder replacement and is used for people who have a severely damaged rotator cuff that cannot be repaired, combined with arthritis. No matter what surgery a patient decides to have done, it is import to understand all the risks involved.
During your evaluation with an orthopedic surgeon, you will undergo a physical examination to assess your shoulder motion, stability and strength, as well as:
- Medical history to determine the extent of your shoulder pain and how it affects your ability to function.
- X-rays to visualize the level of damage in the shoulder, such as irregularities in the bone shape, bone spurs, loose cartilage pieces or a piece of bone floating inside the joint. Abnormal x-rays may reveal a narrowed joint spaces, cysts, bony thickening, or incorrect alignment.
- Blood tests to rule out other conditions requiring treatment.
- MRI scans to evaluate the soft tissues making up the shoulder.
- Bone scan, to assess the density of bone in the area, which can lead to a diagnosis of osteoporosis if you have very fragile bones.
Once your evaluation is complete, you will have a discussion with your doctor about whether shoulder joint replacement surgery could benefit you, while still exploring nonsurgical alternatives.
There are several reasons why a person needs a shoulder replacement surgery, the most common being the different forms of arthritis:
- Osteoarthritis (OA) – A degenerative joint disease known as the “wear and tear” form of arthritis, most common in people 50 years of age or older.
- Rheumatoid arthritis (RA) – A long term disease that causes painful inflammation of joints and surrounding tissues, resulting in pain and stiffness. Also called “inflammatory arthritis.”
- Post-traumatic arthritis – A form of osteoarthritis that sets in after damage to that area occurs, creating severe pain and limiting mobility.
Other causes of severe shoulder joint pain include:
- Rotator cuff tear arthropathy – When severe arthritis and a massive non-reparable rotator cuff tendon tear.
- Avascular necrosis – Also known as osteonecrosis, a disease caused by a temporary or permanent loss of blood supply to the bone, causes the bone tissue to die.
- Severe fractures – if the head of the arm bone shatters or blood supply to the area is at risk of being interrupted.
- Failed Previous Shoulder Replacement Surgery – Sometimes the first replacement surgery is not successful if the implant loosens or there are other complications, meaning you will need a revisional procedure.
Shoulder replacement surgery has become much more advanced in recent years both with newer techniques and instrumentation designed to achieve the best outcome. Materials have improved, too, with titanium and ceramic prostheses and plastic joint liners to increase the longevity of your artificial joint. During a total joint replacement surgery, which is an inpatient procedure that takes approximately two hours, certain parts of a damaged shoulder joint are removed and then replaced with a prosthetic joint, which is designed to move and function as a normal, healthy joint. The prosthesis is comprised of two or three components, which may include:
- The humeral (upper arm) component, a metal piece to be implanted at the site of the humerus.
- The humeral head component.
- The glenoid to replace the surface of the glenoid socket.
You may have a partial or total shoulder joint replacement, dependent on the amount of damage in the area. A partial joint replacement is done when the glenoid socket is intact and only the humeral component is implanted and the humeral head is replaced. A total shoulder joint replacement involves replacing the glenoid socket, as well. Once the prosthesis is implanted, you will have staples or sutures beneath the skin. If you have staples, they will be removed several weeks after surgery.
Benefits of Shoulder Joint Replacement
If you would like to live free of shoulder pain and fully participate in the activities of daily life, you may want to discuss the possibility of shoulder replacement surgery with an orthopedic surgeon. Shoulder joint replacement surgery can help restore normal range of motion to the area, allowing you to rotate your arm in every direction. This can help you do many of the daily activities you haven’t been able to do in years, before your shoulder problems began. The most significant difference will be the relief of shoulder pain once your shoulder heals. Your shoulder will be more mobile, comfortable and much less stiff.
Risks and Complications of Shoulder Joint Replacement
Serious risks from shoulder replacement surgery are rare, but do exist in a minority of patients. All surgery has inherent risks, which may include infection, bleeding, and blood clots. Recent improvements in the techniques used for joint replacement surgery can increase your odds of having a successful outcome. Your doctor will only suggest shoulder joint replacement surgery if the potential benefits outweigh the associated risks. Keep in mind that even a successful shoulder joint replacement procedure will not allow you to do more than you could before joint problems developed. A patient is also advised to keep their weight in a normal range, as the likelihood of joint wear and loosening increases with weight gain. Risks specific to shoulder replacement surgery include:
- Nerve injury, especially from the many nerves and blood vessels travelling through the armpit area.
- Dislocation, particularly right after the operation.
- Joint infection occurs in less than 2 percent of all patients.
- Need for revisional surgery if the prosthesis becomes loose, unstable or worn out.
As you begin the healing process, your doctor will give you antibiotics to prevent the possibility of infection, as well as pain medication. Pain management is considered an important part of the recovery process, which includes beginning physical therapy to help relieve any pain and regain strength in the shoulder. You will be allowed to go home from the hospital after one to three days following surgery.
As you leave the hospital, your arm will be in a sling and should be worn for the first two to four weeks after surgery to better support and protect the shoulder. Your incision area must be kept dry and checked daily for any excessive swelling or drainage. Your surgeon will advise you not to use spray deodorants to avoid getting any liquid in the incision area.
As you heal, make sure to follow your surgeon’s instructions for home care, such as being careful not to push yourself up from your affected shoulder/arm, as this requires forceful muscle contraction. Similarly, you should avoid any heavy lifting, or picking up any object with your affected arm that is heavier than a glass of water for at least 2-4 weeks. You should be ginger with the affected arm, and not place it in any extreme position such as straight out to the side or behind your body.
Expect recovery to take time as pain subsides and you regain shoulder strength. Rehabilitation may not always be a steady process, but you must persevere and not get discouraged. If you have any unexpected problems, questions or concerns, contact your surgeon. Symptoms such as fever, sudden pain increase or excessive drainage should be reported promptly.
Unrestricted use of the affected arm may begin as early as eight week following the operation, or as directed by your surgeon.
Shoulder joint replacements are better than ever. The advancements made in recent years allow for a minimally invasive procedure with minimal healing time as well. It's time you finally treated your shoulder joints with top-of-the-line treatment. If you are interested in learning more about shoulder joint replacement, as well as other treatments for orthopedic conditions in Los Angeles, please call West Medical at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.
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