Shoulder replacement surgery

Shoulder replacement surgery is offered to people experiencing severe pain due to arthritis or a very severe fracture of the upper humerus.

Arthritis is a degenerative condition that causes the cartilage lining your shoulder joint to wear away. Cartilage helps the ball at the top of your upper arm to move smoothly inside your shoulder socket.

As the cartilage wears away, the bones can begin rubbing together causing the joint to become painful and stiff.

Over time bony spurs can develop.

Shoulder replacement surgery entails removing the damaged shoulder joint and replacing it with a prosthetic implant, made of highly refined metal and plastic. Your doctor will normally advise you to delay shoulder replacement until there is significant pain and loss of movement. This is because the replaced joint is prone to wearing out over time, as it is not a living material and therefore cannot regenerate or heal itself. How quickly it wears out is dependent on your activity levels and lifespan.

Thankfully because of this advice, advances in surgical technique, and the quality of materials used, the vast majority of patients receiving a shoulder replacement never need it to be changed.

Shoulder replacement generally provides effective, long-lasting relief from pain, improved mobility and a better quality of life. Like all surgery it carries risks. Your surgeon will discuss these with you in more detail so that you can come to a decision as to whether it is the right operation for you.

There are different types of shoulder replacement:

• Reverse shoulder replacement is performed most often. It involves switching the position of the ball and socket in your joint. A metal ball is attached to your shoulder blade where the socket used to be and a new socket is attached to the upper arm where the ball was originally. It is very useful for patients who have a tear or weakness in their rotator cuff, have a very misshapen socket due to excessive wear over the years, or have sustained a severe fracture.
  
• Total shoulder replacement mimics the natural structure of your shoulder. The ball at the top of your upper arm is replaced with a metal ball and the socket in your shoulder blade is replaced with an artificial socket. It is most often used for younger patients who have strong rotator cuff muscles.
  
• Partial shoulder replacement involves replacing only the ball at the top of your upper arm with a new metal ball. Your natural shoulder socket is left intact. This was very popular in the past, and is still used for many patients with good reason.

Your surgeon will advise on the best type of surgery for you.

Shoulder replacement surgery is carried out under general anaesthetic. The procedure normally takes around two hours. The surgeon will make an incision at the front of your shoulder, working between the main muscles of your shoulder rather than cutting through them. The damaged joint or parts of the joint will be removed and replaced with artificial implants, which are sometimes held in place with special cement. Afterwards the incision will be closed with dissolving stitches.

You will be given pain relief to help manage any discomfort experienced as the anaesthetic wears off. Depending on your state of health and how quickly you recover you will normally need to stay in hospital between one and two days. An X-ray will be taken of your new joint to check that it is functioning as expected.

You will see a physiotherapist who will recommend exercises to help prevent shoulder stiffness and encourage healing. You should do these exercises regularly as well as following advice about the best way to move your shoulder to protect your new joint. You may need to wear a sling for up to four weeks, particularly at night.

In the first few weeks you may need help with tasks like washing and dressing yourself. It is important not to lift anything heavier than a cup of tea in the first six weeks and you should avoid heavy lifting and strenuous sports for six months. It normally takes between three and six months to recover fully from shoulder replacement surgery.