What is a shoulder replacement?

A shoulder replacement is a procedure that can be very successful in relieving joint pain and restoring shoulder range of movement.

In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options of the glenohumeral joint (ball and socket joint) are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).

When is it necessary to have a shoulder replacement?

If non-surgical treatments like medications, activity modification or physiotherapy are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery.

Shoulder replacement surgery is a safe and effective procedure to relieve pain, restore range of movement and help you resume everyday activities.

A shoulder replacement is commonly performed to treat:

• Osteoarthritis (degenerative or wear and tear) arthritis
• Rheumatoid arthritis
• Post trauma arthritis
• Rotator cuff tear arthritis
• Severe fractures
• When the bones suffer from loss of blood supply (called avascular necrosis)

What are the shoulder replacement options?

Shoulder replacement surgery is highly technical. Your Melbourne Arm Clinic orthopaedic surgeon is fellowship trained to performing these operations.

There are different types of shoulder replacements. Your surgeon will evaluate your situation carefully before making any decisions. He will discuss with you which type of replacement would best meet your health needs. Do not hesitate to ask what type of implant will be used in your situation, and why that choice is right for you.

The common options include conventional total shoulder replacement, shoulder resurfacing replacement or reverse total shoulder replacement.

Total shoulder replacement

• The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.
• Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Shoulder resurfacing replacement

• Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a stem.
• With its bone preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard stemmed shoulder replacement.
• Resurfacing hemiarthroplasty may be an option for you if:
• The glenoid still has an intact cartilage surface
• There has been no fresh fracture of the humeral neck or head
• There is a desire to preserve humeral bone
• For patients who are young or very active, resurfacing hemiarthroplasty avoids the risks of component wear and loosening that may occur with conventional total shoulder replacements in this patient population.
• Due to its more conservative nature, resurfacing hemiarthroplasty may be easier to convert to total shoulder replacement, if necessary at a later time.

Reverse total shoulder replacement

• This is used for patients with torn rotator cuff tendons and arm weakness
• It is also useful if the joint has been severely damaged by severe arthritis or when a previous shoulder replacement has failed or when you have sustained a severe shoulder fracture.
• For these individuals, a conventional total shoulder replacement can still leave them with pain. They may also be unable to lift their arm up past a 90-degree angle. Not being able to lift one’s arm away from the side can be severely debilitating.
• In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

How long is the recovery from shoulder replacement surgery?

You will need to recover in hospital overnight to control pain and learn exercises from the physiotherapist.

The recovery and rehabilitation process starts immediately and will be tailored depending on the type of shoulder replacement you have had. Whilst exercises will start immediately, your shoulder will be rested for 4 weeks in sling.

The shoulder replacement rehab process should have you feeling comfortable by about 3 months.