Total Shoulder Replacement
What is a shoulder replacement?
A shoulder replacement is also known as ‘shoulder arthroplasty’, and is an operation that replaces the damaged joint with an implant (also known as a ‘prosthesis’). The types of implants used can either replace part or all of the shoulder joint. A total shoulder replacement involves placing an implant on both the socket side (glenoid) and the ball side (head of the humerus). Furthermore, the geometry of the implant used can either be ‘anatomic’ which aims to closely replicate the natural anatomy of the shoulder, or ‘reversed’ which aims to compensate for weak or damaged muscles around the shoulder.
What conditions is a total shoulder replacement used for?
A total shoulder replacement may be a surgical option for several conditions affecting the shoulder. These include:
- Osteoarthritis – a degenerative condition leading to damage of the joint cartilage of the shoulder.
- Rheumatoid arthritis – an autoimmune condition which leads to inflammation of the lining (synovium) of the joint, which eventually leads to destruction of the joint cartilage.
- Post traumatic arthritis – damage to the joint cartilage as a result of a fracture involving the joint surface, or due to recurrent dislocations.
- Rotator cuff arthropathy – as a result of long-standing damage to the rotator cuff tendons supporting the shoulder, altered biomechanics leads to eventual joint surface disease.
- Avascular necrosis – loss of blood supply to the bone of the humeral head leads to collapse and destruction of the joint.
- Fracture – a bad broken bone involving the upper part of the humerus may not be reconstructable and joint replacement may be a more reliable solution.
Is a shoulder replacement the right option for you?
The diseased and damaged shoulder can lead to many problems. The main symptoms are pain and stiffness. When these symptoms begin to impact on quality of life and function in daily life, then it may be time to consider a shoulder replacement.
Evaluation for a shoulder replacement
Prior to consideration of a shoulder replacement for arthritis, the non-operative options should be trialled. These will include simple analgesia and anti-inflammatory medication, trial of corticosteroid injections, and physiotherapy to improve function. Should these non-operative measures be unsuccessful, then you will be evaluated to see if you are a candidate for shoulder replacement surgery.
What’s involved in a shoulder replacement?
The skin incision for a shoulder replacement is made over the front and outer aspect of the shoulder. It is 10-12cm in length. The tendons of the rotator cuff muscles are inspected and the subscapularis muscle is lifted from the bone in order to give access to the joint. This muscle is repaired at the end of the procedure.
The joint surfaces are then inspected and removed. The implants are then sized, trialled and implanted. In an ‘anatomic’ shoulder replacement, the cup of the implant is inserted on the cup of the shoulder blade (glenoid), and the ball of the implant is inserted into the arm bone (humerus). In a ‘reverse’ shoulder replacement, the geometry is reversed. That is, the cup of the implant is inserted on the humerus, and the ball of the implant is inserted on the glenoid. This design helps to compensate for a weak or torn rotator cuff.
Following insertion of the implants, the shoulder is tested for range of motion and stability. The subscapularis muscle is repaired and the incision is closed using absorbable stitches.
As with any surgical procedure, there is a small risk of:
- Wound healing problems
- Cardiovascular risks – stroke, heart attack, blood clots
- Swelling of the operated limb – generally subsides within weeks to months.
- Pain – discomfort is expected after an operation, however pain medications are used in a routine manner to relieve this post-operative discomfort
Specific risks of a total shoulder replacement are:
- Damage to nerves around the shoulder
- Stiffness or ‘frozen shoulder’
- Failure of tendon healing
- Loosening of the implant
- Infection of the implant
- Fracture around the implant
- Revision surgery
What happens after a shoulder replacement operation?
Postoperative instructions and follow up
- Immediate post-op
After your operation you will be taken to the recovery room of the hospital, and allowed to have something to drink. When the team is happy the anaesthetic has worn off, you will be transferred to the day surgery area or to your inpatient room depending on whether you will be staying overnight.
A sling / shoulder immobiliser would have been placed on your arm in the operating room, and should keep your arm comfortable and safe. This will be worn for 4 weeks at all times except for showering and during rehabilitation.
If a nerve block has been performed by our anaesthetist, then your arm should feel comfortable but numb for up to 24-36 hours after the operation. When pins-and-needles are felt in the hand and arm then the block is starting to wear off, and your nursing staff will commence pain medication to keep you comfortable.
- Discharge from hospital
Normally following a shoulder replacement, you will be admitted to hospital for 2 to 3 days.
On discharge from hospital you will be given:
- Physiotherapy – instructions on exercises that should commence for the shoulder, elbow and wrist.
- Sling – instructions on the use of your sling, including whether it is allowed to be removed, and how to do this.
- Dressings – please keep dressings dry and do not remove them.
- Follow up appointment time
- Follow up
A follow up appointment will have been made for you after the operation. This will typically be an appointment around the 2-3 weeks after the surgery. If you have any concerns before this appointment, call Dr Yu’s clinic on (08) 7099 0188 to speak with us.
Preparing for a shoulder replacement
- Medication review
As part of your preoperative assessment, your current regular medications will be reviewed. This includes over-the-counter medications as well as supplements eg. Fish oil and glucosamine.
You will be able to continue taking the majority of your regular medications, however some medications may be temporarily ceased. These are usually blood-thinning medicines (anti-coagulants) including (but not limited to) aspirin, warfarin, clopidogrel, apixaban. Diabetes medications including tablets and injections can usually be safely continued until the morning of the surgery.
We will advise you when to stop taking these medications before the operation, and when to restart them after the operation.
Smoking greatly impairs the blood supply to healing tissues by constricting the blood vessels, as well as creating problems with anaesthesia. If ever there was a good time to quit smoking, it is before an operation and during the recovery period. You will be advised of options to help ceasing smoking during this period, and ideally beyond.
No solid food (including drinks containing milk) should be consumed within 6 hours before surgery. Clear fluids (such as cordial and water) may be consumed up to 3 hours before surgery, and then nothing should be taken from then (this includes chewing gum).
An exception is made for regular oral medications, which can be taken with a small sip of water.
- Cardiovascular fitness
An operation most often requires general anaesthesia (meaning you are put to sleep and breathing is assisted). Dr Yu and his anaesthetic team endeavour to make your anaesthetic as safe as possible by ensuring your heart and lungs are in optimal health. This may mean a pre-anaesthetic review by our anaesthetist involving a cardiovascular assessment, with blood tests and heart tracings performed.
- Skin preparation
You should not shave or wax skin around the surgical area, as this can irritate the skin or cause superficial infections. Please advise us if you notice any skin lesions or abrasions around the operative area in the days before your surgery. Whilst waiting for your operation on the day of surgery, we will prepare the skin with antiseptic, and Dr Yu will mark the limb to be operated on.
- Illness / colds
Please advise us as early as possible if you have a cold or flu-like symptoms, or urinary-tract infections so that these can be treated.Your surgery may need to be postponed while you recover from these infections. This is to ensure your surgery is performed as safely as possible for you.
Please bring all relevant imaging with you to hospital (eg. X-rays / CT scans / MRI scans).
- Arrival to hospital
Please present to the hospital surgical admissions area at least 2 hours before your planned surgery, or as advised by the hospital admission staff. If you are planned for an overnight admission to hospital following the operation, please bring your regular medications with you.
Do you have a shoulder problem?
Contact our team to find out more.