shoulder replacement
Total and uni-compartmental knee replacements are one of our most common and successful operations. Replacement surgery relieves pain and restores mobility for patients with many types of arthritis.
shoulder arthritis
Many patients with shoulder arthritis suffer silently. It is less common than hip or knee arthritis and many people do not realise that it can also be well treated by replacement surgery.
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Just like other joints the shoulder cartilage can wear out due to osteoarthritis. Other causes include recurrent dislocation of fracture, infection and inflammatory arthritis.
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Symptoms of arthritis are usually dull aching in the arm and shoulder; creaking or catching of the joint, stiffness and inability to lift the arm. Sometimes neck problems can radiate to the shoulder region however, as can nerve compression problems.
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Before considering shoulder replacement surgery you should exhaust all non-operative treatment options. Shoulder surgery is frequently very successful in relieving pain, however all prosthesis have a lifespan and all surgery carries some risks.
irreparable cuff tears
The other reason for shoulder replacement surgery is older patient who suffer from massive rotator cuff tears. The rotator cuff muscles keeps the shoulder joint in it's shallow socket during lifting. Large tears in the elderly may become irreparable. These patients have weakness and may be unable to lift the arm. Eventually a characterist pattern of arthritis develops called 'cuff arthropathy'.
When the shoulder becomes de-stabilised like this a special type of prosthesis called a 'reverse shoulder replacement' is used.
These are also used in severe humeral fractures, glenoid deficiency and commonly in revision shoulder replacement surgery.
Types of shoulder replacement
A shoulder replacement normally refers to an anatomic design. The ball is replaced with a metal spherical head which is fixed inside the humeral bone with a metal stem. The scapular glenoid has a highly cross-linked polyethylene socket cemented in place. This design very closely matches the original shoulder. Your surgeon will decide if you can have this kind of shoulder replacement that has slightly better movement.
Shoulder joints are unique in that they are very mobile, they have a range of motion impossible for the hip or knee. This means that they must have stabilizing muscles for a normal anatomic shoulder replacement. When the rotator cuff is torn this design may be reversed. A hemi-spherical ball is screwed onto the glenoid, and a humeral stem with a polyethylene socket is implanted. The glenoid is often deficient in bone and requires bone graft from the humerus, or metal augmentation with porus titanium wedges in some cases.
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The glenoid is such a small part of the scapula, deep inside the shoulder. CT planning of the operation is undertaken to precisely understand the precise requirements for your shoulder. 3D-printed patient-specific guides are made iin France for your surgery.
Should I have shoulder replacement surgery?
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Shoulder replacement is elective surgery. This means you may want it to improve your quality of life, but nothing terrible will happen if you don't. If you have exhausted all other treatments however it may be the best long term solution for pain relief and regaining your mobility.
There are at least 3 questions your surgeon will consider:
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Is a shoulder replacement the right solution for your symptom?
Your surgeon will discuss your shoulder problems, examine your shoulder and review x-rays, and often MRI and CT scans and advise you about this. -
How old are you?
Sometimes patient think they are too old. Your surgeon however only wants to know how fit you are. In some respects older patient will do better as they wear their prosthesis slower. Younger patients have a greater concern as they might need to have revision surgery in the future. -
Is your condition worth going through surgery?
This is a personal question for each patient. You need to talk in detail with your surgeon about the risks and benefits. Even if your x-rays look worn, if you are functioning well without frequent pain then you don't need surgery.
What to expect?
A normal well functioning shoulder replacement should give you years of comfortable movement. The shoulder should feel strong and allow you to reach, lift and sleep comfortably.
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The primary reason to have surgery is to relieve pain and this is usually successful. The secondary reason for surgery is movement - most patients can easily reach a shelf above head in time. You should expect some limitation in movement for some months, and full range won't be achieved until a year.
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There will be post-surgery pain but you will have medications to help with this. Many patients shoulder pain is improved immediately however if their arthritis is severe. You will have some arm swelling and need to wear a sling. Most patients are in hospital only 1 day, and a wound check appointment is scheduled at 10-14 days after surgery to ensure the skin healed and no signs of infection. You will have x-rays before and after surgery.
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You will initially use a sling mostly for the first 3-4 weeks. You should start physio within 2 weeks. the first 6 weeks is focused on protecting the muscle repair; full strengthening starts at about 12 weeks. There are certain shoulder positions and movements the need to be protected until 3 months.
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More details are available in our information for patients section.
Risks of shoulder surgery
All surgery has risks and this is moderately large surgery. There are general risks of all surgery/anaethetic of this magnitude which include: risks of surgery and anesthetic including stroke, heart attack and even death. You will be assessed first and all measures to ensure these are minimal.
With all joint replacement surgery infection is a concern and may affect 1 or 2%. This can require further operations or antibiotics. You will be given antibiotics before the surgery starts and meticulous sterile care in taken in operating theatre.
Dislocation of the hip replacement is another concern. All ball and socket joints can dislocation if pushed too far. You will be shown what positions are not safe. Generally however these restrictions are less than the stiffness most patients had from their arthritis in the first place however.
A small change in leg length is also possible. Particularly when your surgeon is trying to ensure your hip has a minimum tension and clearance to avoid dislocation. You may also feel slightly longer as the hip replacement may aim to restore the length caused by bone collapse and loss of cartilage.
More information is available in our information for patients section.