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Shoulder replacement

A shoulder replacement involves replacing your shoulder joint if it has been damaged or worn away, usually by arthritis or injury.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Your shoulder is a ball and socket joint. The ball at the top of your upper arm moves smoothly in the socket of your shoulder blade on a lining of cartilage. The shiny cartilage prevents your bones from rubbing together. If your cartilage is damaged by injury or worn away by arthritis, it can make your joint painful and stiff.

A new shoulder joint can help to improve your mobility and reduce pain. Artificial shoulder parts are usually made of metal or plastic, or a combination of these.

There are several different types of shoulder replacement.

  • In a partial shoulder replacement (also known as hemiarthroplasty), part of your shoulder joint is replaced, usually at the top of your upper arm.
  • In a total shoulder replacement (shoulder arthroplasty), an artificial ball is attached to the top of your upper arm. An artificial socket is also attached to your shoulder blade.
  • In a reverse shoulder replacement, an artificial ball is attached to your shoulder blade. An artificial socket is also fitted to the top of your upper arm.

An artificial shoulder joint will usually last for at least 10 years, after which time you may need to have it replaced.

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Details

  • Preparation Preparing for a shoulder replacement

    Shoulder replacement is carried out by an orthopaedic surgeon (a doctor who specialises in bone surgery). Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

    You will have a shoulder replacement under either general anaesthesia or local anaesthesia. General anaesthesia means you will be asleep during the operation. Local anaesthesia completely blocks pain from your shoulder and you will stay awake during the operation. You surgeon will advise you which type of anaesthesia is most suitable for you. You might have a sedative as well as local anaesthetic. This relieves anxiety and will help you to relax.

    If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.

    You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to sign a consent form.

    Bupa On Demand: Musculoskeletal services

    If you are concerned about your muscles, bones and joints, Bupa can help you get a diagnosis.

  • Alternatives What are the alternatives to shoulder replacement?

    Your surgeon will usually only recommend that you have surgery if other treatments haven’t worked for you. These may include:

    Shoulder resurfacing is an alternative surgical option. Ask your surgeon to explain if this is an option for you.

  • The procedure What happens during a shoulder replacement?

    Shoulder replacement usually takes around two hours, depending on how complicated your surgery is.

    Once the anaesthesia has taken effect, your surgeon will make a cut, usually down the front of your shoulder.

    Your surgeon will remove some of the humeral head (the top of your upper arm bone). The artificial ball on a stem is then fixed in place with special cement. He or she will then prepare the surface of the socket and fix the new artificial socket in place. Your surgeon will then put the two halves of your shoulder joint back together (putting the ball into the socket).

    Your surgeon will close the cut with stitches and cover the wound with a dressing.

  • Muscle, bone and joint treatment

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including muscle, bone and joint treatment.

  • Aftercare What to expect afterwards

    You may need to stay in hospital for two or three days after your operation.

    You may need to rest until the effects of the anaesthetic have passed. If you have a local anaesthetic, it may take several hours before the feeling comes back into your treated shoulder. Take special care not to bump or knock the area.

    You may need pain relief to help with any discomfort as the anaesthetic wears off.

    You may have fine tubes running out from your wound. These drain fluid into a bag and are usually removed after a day or two. When you feel ready, you can begin to drink and eat.

    You may be wearing compression stockings on your legs to help maintain circulation. You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs.

    A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will visit you after your operation. He or she will guide you through exercises to help you recover. Your physiotherapist will encourage you to move your shoulder from the first day after your operation. This helps to prevent stiffness and will help your shoulder to heal.

    Your nurse may give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

    General anaesthesia can temporarily affect your co-ordination and reasoning skills. Therefore you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice. Most people are able to drive about two to four weeks after the operation.

    The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about six weeks.

  • Recovery Recovering from a shoulder replacement

    It usually takes at least three months to make a full recovery from a shoulder replacement. However, this varies between individuals, so it's important to follow your surgeon's advice.

    You may need to keep your arm in a sling for several weeks after the operation.

    You should be able to look after yourself and eat and dress within a few weeks after surgery. Don't place your arm in any extreme positions (such as straight out to your side or behind your back) for six weeks after your operation.

    Your surgeon may recommend that you don't do any heavy lifting for up to six weeks after your operation. It's best not to do any repetitive heavy lifting at all after the operation as this will help your new joint to last.

    Ask your surgeon for advice about returning to work and other activities.

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.

    It’s important to continue to do the exercises your physiotherapist recommends. These will help your shoulder to heal and may help you to recover more quickly.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with a shoulder replacement. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the operation.

    After shoulder replacement surgery, your shoulder and arm may be sore or uncomfortable for several weeks. You may also have some swelling around your shoulder.

    Complications

    Complications are when problems occur during or after the operation.

    The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. You may also develop a blood clot, usually in a vein in the leg (deep vein thrombosis).

    Some of the complications of shoulder replacement are listed below.

    • Your shoulder joint may become unstable. This happens when the top of your upper arm moves out of its socket (the top of your shoulder blade). It's caused by problems with the muscles or ligaments around your shoulder joint.
    • Occasionally, small cracks in your bone may cause one of your shoulder bones (the humerus or scapula) to crack completely (fracture). You can have treatment for this but it may slow down your recovery.
    • Infection of the wound or joint. Your surgeon may give you antibiotics during surgery to help prevent this.
    • Accidental damage to your shoulder joint, including nerves, muscles and blood vessels around your shoulder.
  • FAQs FAQs

    How much pain will I be in after my shoulder replacement operation?

    Answer

    The amount of pain you may have after your shoulder replacement can differ from person to person. Speak to your surgeon about managing your pain after your operation.

    Explanation

    Immediately after your operation, and when you’re in hospital, you will be given medicines for pain relief. You may be given an injection, tablets to swallow, or have medicine given to you by a patient-controlled system. This allows you to control the amount of pain relief you receive.

    When you’re recovering at home, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that come with your medicine and of you have any questions, ask your pharmacist for advice.

    If your pain is severe or doesn’t improve, contact your GP or surgeon for more advice.

    What exercises can I do to help my recovery from a shoulder replacement?

    Answer

    The best way to help your recovery is to follow the exercises your surgeon and physiotherapist give you after your operation.

    Explanation

    Your physiotherapist will give you a number of different exercises to do that will help your recovery after a shoulder replacement.

    The type of exercises you need to do will depend on the reasons for your shoulder replacement. Most exercises will help to get your shoulder joint moving and strengthen the muscles around your shoulder. Your surgeon and physiotherapist will decide the type of exercises that you will need to do. They will also decide how many and how often you need to do them.

    It’s important to keep up with your physiotherapy exercises as these will help you recover. Speak to your physiotherapist if you have any questions or concerns about the exercises you’re doing.

    Will I need to have more than one shoulder replacement?

    Answer

    An artificial joint will usually last for at least 10 years, after which you may need to have another operation to replace it.

    Explanation

    Your shoulder replacement should last for at least 10 years. After this, the artificial parts of the joint may start to loosen from general wear and tear.

    A repeat shoulder replacement operation is also known as a revision. If you need to have your artificial joint replaced, the procedure can be more difficult and complicated. This is because your surgeon will need to remove your artificial joint before he or she can put a new joint in. It’s also possible that your upper arm bone (humerus) will become thinner over time.

    Your surgeon will give you more advice about a second joint replacement if you need one.

  • Resources Resources

    Further information

    Sources

    • Shoulder joint replacement. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published December 2011
    • Singh JA, Sperling J, Buchbinder R, et al. Surgery for shoulder osteoarthritis. Cochrane Database of Systematic Reviews 2010, Issue 10. doi: 10.1002/14651858.CD008089.pub2.
    • Shoulder and elbow replacement. Arthritis Research UK. www.arthritisresearchuk.org, accessed 18 September 2013
    • Metal shoulder joint replacement devices. Medscape. www.emedicine.medscape.com, published 12 July 2013
    • Shoulder hemiarthroplasty. Medscape. www.emedicine.medscape.com, published 2 November 2011
    • Reverse total shoulder replacement. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published September 2010
    • Glenohumeral arthritis overview of the arthritic shoulder. Medscape. www.medscape.com, published 16 September 2013
    • Shoulder resurfacing. National Institute for Health and Care Excellence (NICE), July 2010. www.nice.org.uk
    • Shoulder surgery. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published August 2009
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