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Shoulder Replacement

Most adults are aware-of the existence of hip or knee replacements and perhaps even know someone that has had one. Most people, however, don’t know someone that has had a shoulder replacement. While over 750,000 hip and knee replacements were performed in 2008, only about 50,000 shoulder replacements were performed in the United States during the same year. The shoulder numbers lag behind the other two partly because shoulders aren’t required for mobility. That means when people develop severe arthritis in the shoulder, many are able to compensate by using the other shoulder more, or make do with rest and medication, rather than having surgery.

Like hip and knee replacement, the proper shoulder replacement procedure can offer patients remarkable pain relief and improved function. A study of 50,000 patients published in the journal Clinical Orthopaedics and Related Research found that arthritis patients undergoing total shoulder replacements had fewer complications, shorter lengths of stay, and lower total charges than those undergoing hip or knee replacements. Shoulder replacements are done primarily to relieve pain, and 98% of patients report feeling relief, according to that study. Just like with hip and knee replacements, shoulder replacements don’t last forever. Studies indicate 95% of artificial shoulders function well 15 years after surgery, but that means 5% may need an additional procedure within that time frame, due to wear and tear.

The shoulder joint is remarkable, allowing a broader range of motion than any other joint in the body. The ball-and-socket joint comprises the rounded top of the upper arm bone (the “ball”), which fits into a dish-like cup called the glenoid (the “socket”) in the shoulder blade. In a healthy adult, both are covered by a layer of smooth cartilage, which eases the movement of the ball inside the socket. But injury or arthritis can wear down that padding. In severe cases it lets the bones rub against each other — causing grinding and pain. Treatments such as heat, therapy, and injections may bring some relief, but it’s usually temporary.

Shoulder replacement surgery is also more specialized because there are several different kinds of shoulder replacements each with its own unique indication. To choose the best option for you personally, we recommend choosing an expert with a great deal of experience with all types of shoulder replacements to fit the most appropriate solution for your problem, instead of fitting just one solution to all problems. Here is more information about How to Choose a Surgeon for your Shoulder Replacement.

Here’s a quote from the orthopedic Journal of Shoulder & Elbow Surgery:
“Practice is the repetition of an action to improve its quality. The value of the practice effect is recognized in sports, music, and surgery. The number of times a surgical procedure is performed may have a bearing on how well it is done. We investigated the relative frequency with which hip, knee, and shoulder replacements are performed by individual surgeons. The…..database of the Center for Medical Consumers in New York State revealed that …. only 10 shoulder replacement surgeons (3%) performed 10 or more such procedures; 75% performed only one or two. The distribution of shoulder replacement among surgeons was statistically different than for hip or knee replacement (P <.0001). These findings suggest the need for robust educational programs to minimize the potential adverse effects of low surgeon volume for the patients undergoing these procedures.”
[Reference: 2003 Mar-Apr; 12(2):164-9]

The two most common types of shoulder replacements we perform are the Standard Total Shoulder Replacement and the Reverse Total Shoulder Replacement. In a “standard” total shoulder replacement, we remove the ball and replace it with an artificial one, typically made of metal. The ball is attached to a stem, which is inserted into the upper arm bone. We also replace the socket with one made of plastic. Reverse shoulder replacements are an option for patients with damaged rotator cuffs –the system of muscles and tendons that holds the shoulder joint together. In a reverse shoulder replacement, the artificial “socket” is placed on the arm bone, and the “ball” is attached to the shoulder blade. That allows different muscles to raise the arm.

Total Shoulder Replacement Reverse Total Shoulder Replacement
totalshoulderreplacement2 Reverse-Total-Shoulder

Here is a partial checklist of questions we consider in recommending the best type of shoulder replacement for each patient:

Is the rotator cuff healthy and working?

  • A healthy working rotator cuff is important for the best results with a standard total shoulder replacement.
  • A damaged or dysfunctional rotator cuff can be an indicator that a reverse total shoulder replacement may be the better option.

Is the nerve supply to the shoulder and rotator cuff intact?

  • If the nerve to the rotator cuff is injured or damaged, the rotator cuff function may be compromised.
  • Learn more about Pinched Shoulder Nerve

Other factors considered include:

  • Bone loss and alignment of the shoulder
  • Is the shoulder unstable?
  • Was there a prior failed (inadequate results) shoulder surgery

Both types of shoulder replacements can provide excellent results when chosen for the right patient. Choose a specialist with significant experience using all the options to fit the most appropriate solution for your problem instead of fitting just one solution to all problems.

The surgery itself usually takes a couple of hours, and requires an overnight stay in the hospital. Patients may wear a sling from two to five weeks, and start a self directed or formal rehabilitation protocol (physical therapy) after surgery. Here are our rehabilitation protocols for Total Shoulder Replacement and Reverse Total Shoulder Replacement.

You can find answers to the most frequently asked questions about shoulder replacement and shoulder arthritis here.

For a consultation with a shoulder specialist at The Shoulder Center to discuss if a shoulder replacement is right for you, contact us.