The shoulder is an amazing piece of equipment. It’s a complex but beautifully balanced network of muscles, bones and tendons working in tandem. But it’s also admirably simple. And, most of the time, it works perfectly.
But not always.
When severe problems strike, doctors may step in to do the work of mother nature by recommending a replacement. Shoulder replacements are less common than knee replacements, certainly, but they do happen: over 5,000 operations are carried out in the UK every year.
So what exactly are they? Here’s a brief explanation…
What is shoulder replacement surgery?
Simply put, it’s a repair operation to switch a damaged or diseased shoulder with a new, artificial joint. This artificial joint, or prosthetic implant, is usually made of metal and polyethylene (a kind of plastic). The ‘ball’ of the joint is the metal part. The ‘socket’ is the polyethylene component. The ball is usually fixed into the shaft of the upper arm bone (the humerus). The socket is secured to the glenoid bone with a medical cement. Artificial joints typically last for 10 years before they themselves need replacing, and often much longer.
Why would a shoulder need to be replaced?
The most common reason is osteoarthritis. This is a condition that causes deterioration of cartilage, the smooth covering on bone endings that allows them to move freely against each other. The greater the deterioration, the greater the friction between the ball and the socket. And, as you would expect, friction equals stiffness, decreased movement and pain. But osteoarthritis isn’t the only reason. Replacements are also carried out following post-traumatic arthritis (PTA for short), and for rheumatoid arthritis (an autoimmune disease that causes inflammation of joints around the body). Other reasons include rotator tear complications, severe fractures and avascular necrosis (where blood supply to the bones is reduced).
Who tends to have them?
Since arthritis is most common in older people, most shoulder replacement patients tend to be aged 70 or above. But younger people sometimes have the operation, too.
Is the whole shoulder replaced?
Not necessarily. There are two main kinds of replacement. In a Total Shoulder Replacement (also known as shoulder arthroplasty), both the ball and socket are replaced. In a Partial Shoulder Replacement (a hemiarthroplasty), only one of the parts is used. The difference depends on the extent of the damage.
How do I know if I need a shoulder replacement?
Shoulder replacements are generally only recommended when other treatment options have been exhausted. These might include physiotherapy, anti-inflammatory medication and steroid injections, which focus on managing the damage by reducing pain and inflammation. Keyhole surgery may also be used before replacement is considered. Replacements are best left for cases of severe damage, such as end-stage arthritis. What will this feel like, in practice? Essentially it’s when every area of your life is affected; when daily life feels more miserable than manageable. That’s something we would weigh up carefully in your consultations.
How long will it take to recover?
A shoulder replacement is a major surgical procedure, so recovery takes time. The first two weeks can be surprisingly tough – I sometimes refer to this period as ‘boot camp’. It’s something to be ‘got through’. So the initial emphasis is on recovering from the operation itself. You will wear a sling and rest the wound. After that first fortnight, most people begin to feel signs of recovery. The pain reduces and shoulder movement feels improved. This is usually the turnaround point, and it often encourages people to work hard on the next stage of their recovery…
How can I help my recovery?
By following the specially-designed exercises and physiotherapy that will be recommended for you after the operation. We call this Enhanced Recovery, because the focus is on smoothing the path to full strength – not by simply waiting for recovery, but by mobilising the new joint and the muscles around it. These muscles are likely to be greatly reduced after under-use before the operation. Now is the time to ‘wake them up’ again with careful exercise. We would expect you to lose the sling after two or three weeks. Most patients are able to return to light activities below shoulder height after six weeks, and to heavier and overhead activities after three months. Full strength, however, may not be regained until 12 months.
If you’d like to find out more, why not book an appointment? We would be very happy to discuss your own case, and the best options for your recovery.