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Shoulder Replacement

Total (Anatomic) Shoulder Replacement

This is the typical replacement option for patients with shoulder arthritis and an intact rotator cuff. The “ball” is replaced with a metal stem and sphere while the “socket” (glenoid) is replaced with a new plastic one.

Reverse Total Shoulder Replacement

This type of replacement was initially designed for patients with rotator cuff tear arthritis – a condition characterized by the development of a large, irreparable rotator cuff that, in turn, leads to arthritis. This implant was first approved by the FDA in 2004 after years of success in Europe. The indications for this surgery have expanded to include some fractures in older patients, as well as revision surgery.

Hemiarthroplasty

This surgery involves replacing just the ball component of the joint. The primary role of this implant is for the treatment of some types of fractures.

Is shoulder replacement commonly performed?

Approximately 60,000 shoulder replacements are now done annually. This is in comparison to 600,000 total knees and 300,000 total hips done each year in the United States. This is largely because the shoulder is not a weight bearing joint (we do not walk on our hands), so shoulder arthritis is often better tolerated than hip or knee arthritis.

Overall, shoulder replacement is becoming more common each year as people live longer, more active lives and patients realize that this is a viable option for them.

Is this a new procedure?

No; shoulder replacement has been around for a very long time. The first documented shoulder replacement was in 1893. The modern shoulder replacement began to take form in the 1950s, around the same time as modern hip replacement. These surgeries were both initially performed to treat complex fractures that otherwise would not reliably heal. The modern “total” shoulder replacement – where both sides of the joint are replaced – began in the 1970s, also around the same time as the modern “total” hip replacement.

Is this a safe procedure?

Any surgery carries some level of risk, but shoulder replacement is generally considered a very safe and reliable procedure. A recent review of the Maryland Health Services Database compared the safety of shoulder replacement to that of hip and knee replacement. The study found that shoulder replacement surgery had half the complication rate of hip and knee replacement. Furthermore, when complications did arise, they tended to be less severe than those associated with hip and knee replacements. Shoulder replacement surgery was also associated with shorter hospital stays and lower transfusion rates.

Is the surgery done as an outpatient or inpatient operation?

While most shoulder replacements are performed as inpatients with a one to two night hospital stay, many can be safely performed as an outpatient operation in the appropriate setting with the appropriate patient.

Is shoulder replacement the right surgery for you?

The only indication for shoulder replacement is a painful arthritic shoulder that has failed nonoperative treatment and is no longer tolerable. Ultimately, it is the patient who must decide when that has occurred. People often opt for replacement once the pain becomes so unbearable that it prevents them from performing their normal activities, when it wakes them up at night, and when it fails to respond to conservative treatment.

What can I expect after surgery, and what is the recovery time?

Each patient’s individual experience may vary, but generally speaking, patients often report a dramatic relief in their pain within one to two days of surgery. Typically by that point, patients do not require any pain medications aside from the occasional Tylenol. Most patients are able to perform the majority of post-op exercises in the comfort of their own home without the assistance of a physical therapist. Patients need to be in a sling for six to eight weeks following surgery, just as in rotator cuff repair surgery. At the two to three month mark, a formal physical therapy program is begun, focusing on strengthening the shoulder and getting back to normal activities. Patients are usually fully recovered and can get back to all activities, including swimming, tennis, and golf, within five to six months after surgery. While the primary reason for surgery is pain relief, patients may benefit from improved motion and function of their shoulder.

More information from the American Academy of Orthopaedic Surgeons:
http://orthoinfo.aaos.org/topic.cfm?topic=A00222
http://orthoinfo.aaos.org/topic.cfm?topic=A00094
http://orthoinfo.aaos.org/topic.cfm?topic=A00504