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Total Shoulder Replacement

A shoulder replacement aims to provide pain relief and to give you a shoulder that moves well enough for you to perform daily activities. Shoulder replacement surgery is performed under general anaesthesia and a nerve block.  The average hospital stay is two or three days.  An incision is made over the front of your shoulder. Your contracted soft tissues are released to improve range of motion and your worn out joint surfaces are replaced with precision engineered metal and plastic implants. 

Anatomic Total Shoulder Replacement

If your rotator cuff tendons are in good condition, your surgeon may recommend anatomic total shoulder replacement. In this procedure, your damaged joint surfaces are removed and ‘replicated’ with metal and plastic implants that are tailored to mimic your own anatomy.  Your rotator cuff tendons, which must be intact for this operation to function well, are preserved. The socket side is made of polyethylene (a special hard-wearing plastic) that is fixed into your bone using pegs and a small amount of bone cement.  The humeral side has a very highly polished surface and is made out of either cobalt chrome (a hard-wearing metal alloy) or ceramic.  The humeral implant is either fixed using very short roughened fins that grip the bone (stemless), or by the use of a stem that grips inside the canal of your arm bone.  


Anatomic total shoulder replacement  - metal 'stemless' humeral head and plastic socket (therefore not seen easily on Xray)

Reverse Geometry Total Shoulder Replacement

If your rotator cuff has failed, or is of very poor quality, then you may need a reverse geometry replacement to give you a predicatble outcome.  This involves removal of damaged joint surfaces and implantation with metal and plastic implants, BUT the ball and socket are switched around, so the ball is now fixed into the socket and the socket now lies on the humerus. There is more information on reverse total shoulder replacement in the Treatments section.

Reverse geometry total shoulder replacement – see how the ball lies on the scapula and the socket is now on the humerus

Shoulder Hemiarthroplasty (Half a shoulder replacement)

For some patients, a partial shoulder replacement may be a good option as it is a shorter surgery with a slightly lower complication rate.  The functional improvement may be less than for a total shoulder, but most patients still enjoy good pain relief.  

The choice of what type of surgery to have will be governed by your health, your anatomy, your age and your functional demands and, where possible, by your preference. Do ask Mr Granville-Chapman to discuss the options for your shoulder with you. 

What is my recovery after shoulder replacement surgery?

You will need to stay in for at least one night after surgery. You will wake up with a sling and your arm will still be numb. We will help you achieve pain control as your nerve block wears off (12-24hrs) – sometimes this requires in-patient medication for a day or two after your surgery. You will need a shoulder X-ray and a blood test the day after your operation. Your physiotherapist will go through your rehabilitation plan with you.

Most patients can go home on day two after surgery. Please keep your wound dry and covered with a dressing for 12 days. 

You will come out of your sling between four and six weeks and increase your range of movement exercises. Strengthening will begin at about three months.

Patients vary in their symptoms after surgery, but in general you can expect to return to:

Office work after three or four weeks (in a sling)

Light household activities after six to ten weeks

Heavier activities may take 16-24 weeks

Driving will probably take eight weeks..

How long will my shoulder replacement last me?

The ideal joint replacement functions well for the rest of your life. However, all joint replacements will eventually wear out or loosen. The younger you are when you have surgery, the greater your chance of your replacement wearing out.  For anatomic shoulder replacements, about 90% will last 10 years and many will last much longer than this.  For reverse geometry shoulder replacement, about 85% will last 10 years and again, many will last longer than this. Hemiarthroplasty can last a long time, but in active people, the implant tends to erode the uncovered socket over time.  As this progresses, the pain and loss of function can return.  Most hemiarthroplasties will last 8 years before needing revision. 

What can go wrong during shoulder replacement surgery?

Shoulder replacement surgery is major surgery and some patients suffer complications. General risks of surgery include:

- Anaesthetic problem (1 in 1000) - significant or life threatening problems with your heart, lungs, brain or kidneys are very rare with modern planned surgery.  

- Blood Clot (1 in 500). You will be given stockings to wear and injections during your admisssion to minimise this risk.

- Infection (approx. 2%) . Whilst we undertake every precaution to minimise the risk of infection happening to you, the risk cannot be completely negated.  If you develop infection, you may need removal of your joint replacement, a period on antibiotics and revision surgery.  This is a lengthy and arduous process and the final outcome suffers. Occasionally an infection seeds in a replaced joint through the blood stream.  If you are having dental work you should inform your dentist that you have a joint replacement as they may cover the period with anitbiotics.

- Stiffness (10%).  Range of motion is rarely completely normal after joint replacement. The aim is for you to be able to raise your arm to, or above shoulder height, but sometimes this is not achieved. Inwards and/or outwards rotation of your shoulder may remain quite restricted.

- Instability (1-2%). Your joint replacement relies on implant positioning, soft tissue balance and muscle forces for stability. If the soft tissues become deficient, or there is a problem with your implant position, then your shoulder may become unstable.  If this is recurrent, this may require revision surgery.

- Pain (5-10%).  The vast majority of patients enjoy significant pain relief with shoulder replacement, but some patients experience niggling pain on certain movements and, occasionally, more constant pain in their shoulder that doesn’t settle down. Investigations may be needed to explain why your shoulder is painful – occasionally there is low-grade infection, or a structural cause.

- Fracture (1%). This is rare, but can happen as your bones are prepared for replacement.  Fractures can often be treated at the same time as your replacement, but they may occasionally prevent completion of your replacement while the fracture heals. If you fall after a shoulder replacement, your bones may break around the implant.

- Nerve injury (1%). Important nerves pass close to your shoulder joint. While it is very rare for nerves to be cut, they may get stretched during your operation. The risk of nerve injury is higher if you're having revision  surgery as your anatomy can be distorted, adherent to and obscured by scar tissue. Most stretching nerve injuries recover with time, but permanent muscle weakness in the shoulder or arm could result.