Shoulder replacement

Published by Bupa’s Health Information Team, August 2011.

This factsheet is for people having a shoulder replacement, or who would like information about it.

A shoulder replacement involves replacing a shoulder joint that 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.

About shoulder replacement

Your shoulder is a ball and socket joint. Usually, the ball at the top of your upper arm (humerus) moves smoothly in the socket of your shoulder blade (scapula) on a lining of cartilage. The cartilage prevents the 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, plastic, ceramic or a combination of these.

There are several different types of shoulder replacement.

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

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

What are the alternatives to shoulder replacement?

Surgery is usually recommended only if non-surgical treatments haven’t worked for you. This may include physiotherapy, non-steroidal anti-inflammatory medicines or steroid joint injections.

Preparing for a shoulder replacement

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

Your shoulder replacement will be carried out using either general anaesthesia or local anaesthesia. General anaesthesia means you will be asleep during the operation. Local anaesthesia completely blocks pain from the shoulder area and you will stay awake during the operation. You surgeon will advise you which type of anaesthesia is most suitable for you. Often, people have a sedative as well as general or local anaesthesia. A sedative relieves anxiety and helps 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’s advice.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine. You may need to stay in hospital for two or three days after your shoulder replacement.

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, and 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, which you may be asked to do by signing a consent form.

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.

What happens during a shoulder replacement?

Shoulder replacement usually takes around two and a half 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) and fix the artificial ball on a stem with special cement. He or she will then trim the surface of the socket and fix the new artificial socket in place. The two halves of your shoulder joint are then put back together (the ball is put into the socket).

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

What to expect afterwards

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

If you have a general anaesthetic, 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 of your wound. These drain fluid (which is part of the healing process) into a bag and are usually removed after a day or two. When you feel ready, you can begin to drink and eat, starting with clear fluids.

You may also 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.

Genera anaesthesia temporarily affects your co-ordination and reasoning skills, so 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.

A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will visit you after your operation to guide you through exercises to help you recover. You will be encouraged to move your shoulder from the first day after your operation. This helps to prevent stiffness and promotes healing.

Your nurse will 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.

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.

Recovering from a shoulder replacement

It usually takes between three and six months to make a full recovery from shoulder replacement, but 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.

Your surgeon may recommend not doing any heavy lifting for up to six weeks after your operation. He or she will advise you on when you can return to playing sport as this depends on the type of sport you play. Follow your surgeon’s advice about driving. Don’t drive until you’re confident that you can control the car and perform an emergency stop without discomfort.

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 with the exercises recommended by your physiotherapist. These will aid healing and may help you to recover more quickly.

What are the risks?

As with every procedure, there are some risks associated with 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 surgery, your shoulder and arm may be sore or uncomfortable for several weeks. You may also have some swelling in the upper part of your arm.

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 developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Some of the complications of shoulder replacement are listed below.

• Occasionally, small cracks in the bone may cause one of the shoulder bones (the humerus or scapula) to crack completely (fracture). This can be treated but may slow down your recovery.
• Your shoulder joint may become unstable. This happens when the top of upper arm moves out of its socket (the top of your shoulder blade) caused by problems with the muscles or ligaments around your shoulder joint.
• Infection of the wound or joint. Antibiotics are usually given during surgery to help prevent this.
• Accidental damage to the shoulder joint, including nerves, muscles and blood vessels around the shoulder.
   

 For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.