Total Shoulder Replacement

The primary purpose of a shoulder arthroplasty is to relieve pain. The secondary purpose is to increase range of motion.
- Dr Duckworth

When conservative methods of treatment fail to provide adequate relief, total shoulder replacement is considered.

Total shoulder replacement or shoulder arthroplasty is the replacement of the ball of the upper arm and socket of the shoulder blade with specially designed artificial parts, called prostheses, made of metal or ceramic for the humeral head and polyethylene (a medical-grade plastic) for the socket. The humeral (upper arm) prosthesis consists of a metal or ceramic ball that replaces the head of the humerus which is secured into the upper arm bone. These have now become smaller and are called stemless prostheses as, thanks to modern technology, there is no need to put a stem down the humerus.

The primary purpose of the operation is to relieve pain. The secondary purpose is to increase range of motion. The extent of improvement in your range of motion will depend on the severity of your pre-operative condition, the length of time you have had the problem, the range of motion of your shoulder before the surgery and your commitment to the postoperative rehabilitation.

The glenoid (shoulder blade socket) prosthesis is made of a special polyethylene, and is designed to replace the socket part of the joint. This is inserted with cement.

There are two types of shoulder replacement procedures:

A total shoulder replacement is done when you have standard arthritis and the tendons of your rotator cuff are intact.
A reverse shoulder replacement is where the ball is put on the glenoid and the socket on the humerus. This type of replacement is performed when you have no or very poor rotator cuff tendons or poor rotator cuff tissue.

Learn more about osteoarthritis of the shoulder

How is the operation done?

In the operation only one tendon needs to be cut for the surgeon to get to the shoulder joint. Your shoulder is dislocated at the time of surgery and the ball of the humerus is replaced by a ceramic head. The glenoid or scapula is replaced with a polyethylene prosthesis that is cemented into the bone. The surgeon will use the ones that best resemble your bones at the time of surgery. The joint will then be relocated and put through a series of movements to make sure it is stable. When the surgeon is happy the tendon at the front of your arm is stitched back in place. Your wound is then closed and you are placed in a sling. You will return to the ward in a sling and with a drain to remove any excess blood. After 24 hours the tubing is removed and we will start gentle movement of your arm.

Complications related to the surgery can occur but are quite rare. A general anaesthetic is used and there are risks related to this. Some of the risks include infection, nerve and blood vessel damage, loosening of the prosthesis, fracture at the time of surgery, dislocation, stiffness and ongoing pain, deep vein thrombosis or pulmonary embolism and the need for revision surgery.

Move the slider to compare arthritic shoulder with stemless replacement

Complications related to the surgery can occur but are quite rare. A general anaesthetic is used and there are risks related to this. Some of the risks include infection, nerve and blood vessel damage, loosening of the prosthesis, fracture at the time of surgery, dislocation, stiffness and ongoing pain, deep vein thrombosis or pulmonary embolism and the need for revision surgery.

Move the slider to compare arthritic shoulder with stemless replacement

Frequently Asked Questions

Do I need physiotherapy?
You eventually will need to see a physiotherapist but initially you are considered the best physiotherapist. You will be encouraged to gently start using your arm the day after the operation and will be shown some very simple exercises to do yourself three times a day. You usually start to visit a physiotherapist about 6 weeks after your operation.

Do I need to donate any of my own blood? No, autologous blood donation is not required and post-operative blood transfusions are rare after this type of surgery.

Do I need to go to a rehabilitation hospital?
This is entirely up to you and always depends on how well you manage normally and whether you have help at home.

How long will I stay in hospital?
Usually two to three days but it always depends on how you are feeling.

How long will I wear a sling for?
The sling only needs to be worn for the first few days after the operation then we encourage you to come out of it as much as possible. It is a good idea though to wear the sling when going out of doors to avoid others from knocking or bumping your shoulder.

Is it painful?
You will have some pain following the surgery but each day this will improve with regular pain relief and as the swelling settles down. It is worth noting that patients who have had this surgery regularly say that while it is painful after the surgery, it is often no where near as bad as that which they had before the operation!

When can I drive?
Driving a motor vehicle is usually not recommended until two conditions are met:

It has been at least 6 weeks after the surgery and
The shoulder is comfortable enough so that when you are standing you can raise your arm to the horizontal position straight out in front of you 20 times.
Using these criteria, we avoid placing the shoulder, passengers, other drivers and pedestrians at risk from a shoulder that cannot perform in emergency situations.

Will I need help to feed, shower and dress myself?
We do not recommend soaking in a bath until your wound has healed completely. You will need some assistance with showering until you become more confident. To dress easily, always put your operated arm, through your sleeve first.

Will my shoulder last forever or will I have to have it replaced in years to come?
It is expected that the life-span for the prosthesis will be 10-20 years.