Total/Partial Shoulder Replacement
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Key Takeaway
- Total/partial shoulder replacement is a surgical procedure involving partially or entirely replacing a damaged shoulder joint with prosthetic implants.
- Total/partial shoulder replacement is recommended for various shoulder-related medical conditions and injuries, including osteoarthritis and severe fractures.
- Recovery after a total/partial shoulder replacement will take much faster time than tissue repairs, typically spanning a few days or weeks, before you can resume your daily activities.
What is Total/Partial Shoulder Replacement?
Total or partial shoulder replacement surgery (also known as total or partial shoulder arthroplasty) is an extensive surgical procedure that replaces a part or the entire shoulder joint with artificial implants. This procedure is generally performed to restore shoulder joint functionality and mobility after a severe injury (e.g., fracture-dislocation) or medical condition (e.g., osteoarthritis) that causes damage to the shoulder joint. The extent of surgery required will depend on the nature of the damage to the shoulder joint.
Your shoulder joint uses a ball-and-socket system, where the head (the “ball”) of your upper arm bone (the humerus) that connects to the shoulder blade (scapula) fits into a shallow “socket” (or glenoid) located on the scapula. The bones are also held together by cartilage, tendons, and ligaments, which protect the bones where they meet, facilitate smooth movements, and provide support. There is also a thin, smooth tissue, the synovial membrane, which covers other parts of your shoulder joint. It releases a fluid that helps lubricate the cartilage and reduces friction in your shoulder to allow it to move.
Why is Total/Partial Shoulder Replacement Needed?
When the shoulder joint is damaged or hurt, it can cause various complications, including pain when moving your shoulder or arm, significant inflammation of surrounding bone, muscle and tendon tissue, and reduced range of motion. Severe conditions can adversely impact your physical health and prevent you from performing daily activities like usual. Left untreated, the symptoms can reach a point where you are in constant pain every day, even if you do not move your arm or shoulder. In such cases where nonsurgical interventions do not lead to any improvements, surgery is the last resort to restoring shoulder functionality and mobility.
A total shoulder replacement involves replacing the entire shoulder joint with prostheses. In less severe cases, a partial shoulder replacement is recommended if only a small shoulder area is damaged and requires surgical intervention.
Certain medical conditions may require total/partial shoulder replacement surgery to correct and improve recovery outcomes and safeguard your physical well-being from further harm.
Osteoarthritis
This degenerative joint condition occurs as we age, where the cartilage that cushions the shoulder bones undergoes wear and tear. When this happens, the bones rub against each other, causing pain and gradual stiffness. You cannot prevent osteoarthritis, but various preventive steps and lifestyle changes can help slow its progression; those with osteoarthritis can also opt for a total/partial shoulder replacement to address their condition.
Rheumatoid Arthritis
Rheumatoid arthritis is a form of inflammatory arthritis in which the synovial membrane becomes inflamed and thickened. This can gradually damage the cartilage and cause it to degrade, resulting in pain, discomfort, and stiffness in the shoulder joint.
Osteonecrosis
Also known as avascular necrosis (AVN), osteonecrosis translates as “bone death.” This condition occurs when the blood supply to the shoulder joint is disrupted, causing bone cells to die as they are deprived of nutrition from constant blood flow. As this happens, the bone collapses and the shoulder joint cartilage can degenerate leading to arthritis.
Rotator Cuff Injuries
The rotator cuff consists of several muscles and tendons surrounding the shoulder joint, keeping the joint stable while allowing you to move your arms and lift objects. Any injuries to the rotator cuff can also affect the cartilage and bone in your shoulder joint, which will require a total/partial shoulder replacement.
Fractured/Broken Shoulder
If your shoulder has suffered significant physical trauma, the bones can shatter and make it difficult for surgeons to place the bone fragments back in place carefully. The bone fragments can be compromised of blood supply to the shoulder joint, further complicating fracture healing. In this situation, rather than fixing the fracture, a shoulder replacement may be a better option to restore function.
Available Shoulder Replacement Options
Several types of shoulder replacement procedures are available, each recommended based on the extent of damage to the shoulder joint.
Total Shoulder Replacement
Sometimes called an anatomic total shoulder replacement, this surgical procedure involves replacing the entire shoulder joint with artificial implants. In most cases, this will be a metal ball and a metal or medical-grade plastic socket. The components will be shaped to resemble the actual joint system and sized based on your general body size and bone density in the shoulder joint area.
Reverse Total Shoulder Replacement
While similar to a standard total shoulder replacement, this procedure reverses the ball and socket positions. As such, the artificial ball implant will be affixed to the shoulder blade while the socket is mounted on the upper arm bone. This procedure is performed when a conventional total shoulder replacement needs to be revised because of loosening or if you cannot raise your arm due to massive rotator cuff tears.
Hemi-arthroplasty
A hemi-arthroplasty is a conventional partial shoulder replacement where the surgeon replaces the original ball component with an artificial implant. This procedure is recommended when only the ball requires replacement while the socket remains healthy.
Resurfacing Hemiarthroplasty
Another type of partial shoulder replacement, resurfacing hemiarthroplasty, involves only replacing the joint surface of the upper arm bone’s head with a cap-like implant instead of replacing the entire ball component. This procedure is recommended when the ball joint has only suffered superficial damage that does not warrant a complete replacement.
Revision Shoulder Replacement
Revision shoulder replacement is a corrective surgical procedure when a total/partial shoulder replacement does not lead to better recovery outcomes. It may be needed due to bone or implant instability, sudden infection, fractures, rotator cuff injuries, or poorly fitted implants.
Preparations for Total/Partial Shoulder Replacement
During the initial consultation, you may be subject to a few medical tests to help the doctor determine the extent of damage to your shoulder joint and if you are a suitable candidate for a total/partial shoulder replacement. A physical exam will help assess your shoulder’s range of motion, stability, and strength. Imaging tests (such as X-ray scans) may also be necessary to look for possible signs of arthritis, fractures, bony fragments or overgrowth, or damaged cartilage. Additional tests such as MRI scan or CT scan, may be ordered if your doctor thinks it is necessary.
Your medical team will constantly communicate with you about your treatment and the general dos and don’ts in preparation for surgery. Ensure you ask your doctor as many questions as possible about your condition, outlook, potential risk factors, and how you can prepare for treatment.
Before Total/Partial Shoulder Replacement Surgery
It helps to check with your doctor before your surgery. For example, are there any medications you need to stop taking before your surgery, or what other items do you need to bring with you? Consult this checklist to help you prepare for the appointed surgical procedure.
- Clothing: Wear a loose-fitting button-down shirt that will be easy to wear when you have a sling after the procedure. The sling is essential for immobilising your arm and shoulder to help you heal faster.
- Medications: Bring a list of medications you take for any illnesses or conditions to your doctor. You may be asked to pause taking certain medicines for a few days or weeks until after the procedure.
- Food and drinks: Avoid eating or drinking anything after midnight the night before your surgery. If you need certain medications, take them with small sips of water.
- Rest: While you may feel anxious about the procedure, it helps to get an early night’s rest before your surgery.
- Companion: Have someone accompany you to the hospital. You will need someone to help you drive between the surgery location and your home. Having someone to keep you company may help with recovery as well as support.
On the day of the surgery, you will undergo one last health assessment before you change into a surgical gown and wait for the procedure to begin.
During Total/Partial Shoulder Replacement Surgery
You will be placed under general anaesthesia for the entirety of the surgical procedure, so you will not feel anything throughout the procedure and will only wake up when the surgery is complete.
The surgeon will start by carefully cutting into the shoulder joint area, then gently moving the deltoid and pectoral muscles aside to avoid causing nerve damage. Once done, they will carefully make another incision to access the shoulder joint, cutting one of the front muscles of the rotator cuff that covers the shoulder. This will give them a clear view and unobstructed access to the damaged joint and nearby structures.
Depending on the type of shoulder replacement needed, the surgeon will first remove any damaged sections of the shoulder joint before inserting the artificial implants to replace the damaged joint. The surgeon will carefully attach the implants to where they need to go and ensure they are stable and firmly affixed in place. Once everything looks satisfactory, the surgeon will stitch the incisions shut and clean the wounds.
After Total/Partial Shoulder Replacement Surgery
You usually need to rest a few days in the hospital while your doctor monitors your condition. Before you are discharged, you will be taught how to wear and fit your sling comfortably to allow your shoulder joint to heal properly. You may also receive postoperative instructions to ensure your recovery proceeds smoothly.
- Avoid using the affected shoulder and arm too much, especially lifting items regardless of weight.
- Avoid placing your arm in any extreme position (i.e., behind your body) to prevent unwanted complications.
- Your rehabilitation program starts when you are discharged, so attend scheduled physical therapy sessions (if applicable) regularly to ensure you can recover quickly.
- Exercise regularly at home to help your recovery and prevent gradual muscle degradation. Avoid overexerting yourself during your home sessions.
- Avoid soaking your surgical wound in water until it is fully healed. You will also be taught how to maintain the surgical dressing covering the wound, which needs to be replaced at regular intervals until the wound completely heals.
- Wear the sling for as long as your doctor instructs you to. The sling ensures your shoulder has sufficient support and immobilises it to help with recovery outcomes.
- Have someone around who can help you around the house while you are recovering to maximise recovery outcomes.
- Attend follow-up sessions with your doctor (if applicable) so they can monitor your recovery’s progression.
If everything goes well, you should be able to resume simple, gentle daily living activities two to six weeks after your surgery. Your shoulder’s range of motion and strength will gradually improve over the following months, with some people reporting a full recovery in about six to twelve months.
Frequently Asked Questions
As long as you follow your doctor’s postoperative instructions closely, total/partial shoulder replacement can help to relieve pain and restore your shoulder’s mobility and range of motion. The success rates for total shoulder replacement surgery are usually very good, if you comply with rehabilitation post surgery.
You should use your other arm to lift items and allow your shoulder to recover completely before using it for daily tasks. Your doctor will advise you on what items you can lift with the affected arm, but you will need to rest and recover for some time before trying. Generally small loads up to 5kg will be ok.
In most cases, you will need to wear the sling for two to six weeks, though this may vary from person to person.
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