There are several different types of shoulder replacement.
- 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. So the ball and socket have ‘switched places’.
- In a partial shoulder replacement, part of your shoulder joint is replaced, usually the ball at the top of your upper arm. This procedure is also known as hemiarthroplasty, as only half the joint is replaced.
Your surgeon will discuss with you what would be the best procedure in your particular circumstances.
Most hospitals invite you for a pre-admission visit a week or so before your surgery. In the clinic they’ll check that you’re fit for your operation and the anaesthetic. This visit gives you a chance to ask any questions you have about your admission. You’ll be told how to prepare for your procedure. For example, if you smoke, you’ll be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Before you go into hospital it’s good to think about how you’re going to manage at home afterwards. Is everything you need within easy reach? You may want to have someone stay with you for a while after your operation, to help out. And make sure you have someone to take you to the hospital and bring you home after your operation. Plan to be away from home for between two and five days.
If you’re having a general anaesthetic, you’ll have been 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 ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, your doctor will ask you to sign a consent form.
Your surgeon will usually only recommend that you have surgery if other treatments haven’t worked for you. These may include:
- non-steroidal anti-inflammatory medicines
- steroid joint injections
- shoulder arthroscopy (keyhole surgery)
Shoulder resurfacing is an alternative surgical option. Ask your surgeon to explain if this is an option for you.
Shoulder replacement is carried out by an orthopaedic surgeon (a doctor who specialises in bone surgery). The procedure usually takes around two hours, depending on how complicated your surgery is.
You’ll have a shoulder replacement under either general anaesthesia or local (regional) anaesthesia. General anaesthesia means you’ll be asleep during the operation. Local anaesthesia completely blocks pain from your shoulder and you’ll stay awake during the operation. In some cases you may have both types of anaesthesia, to help ease pain after your surgery. Your surgeon will talk to you about which type of anaesthesia is best for you. You might have a sedative as well as local anaesthetic. This relieves anxiety and will help you to relax.
Once the anaesthesia has taken effect, your surgeon will reach your shoulder joint by making a cut, usually down the front of your shoulder.
After completing the chosen replacement procedure your surgeon will close the cut with stitches or clips and cover the wound with a dressing.
You may need to stay in hospital for two to five days after your operation, depending on how good your general health is.
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’ll be given pain relief to help with any discomfort as the anaesthetic wears off. Tell your nurse if you’re in pain.
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. Your nurse will encourage you 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. They’ll 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. It’s important that you follow their advice about how to move your shoulder.
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.
Having a general anaesthetic can temporarily affect your co-ordination and reasoning skills. So you mustn’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.
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.
Side-effects are the unwanted but mostly temporary effects you may get after having the operation.
After shoulder replacement surgery you may have pins and needles in your arm and fingers, especially if you’ve had a local (regional) anaesthetic. These should soon settle. After the operation your shoulder and arm may be sore or uncomfortable for several weeks. You may also have some stiffness around your shoulder.
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 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 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.
It’s natural to feel some pain after a surgical operation, but don’t worry – you’ll be given pain relief.
Immediately after your operation, and when you’re in hospital, you’ll be given pain-relieving medicines. 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.
In some cases, even if you have a general anaesthetic, your doctor will also inject a local (regional) anaesthetic into your shoulder. This then continues to numb your shoulder even after you wake up.
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 the hospital or your surgeon for more advice.
Your physiotherapist will give you an exercise plan to 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 best type of exercises for you. They’ll advise how many, and how often you need to do them. It’s really important that you follow their advice about what you should, and shouldn’t do with your shoulder. That will give you the best chance for a good recovery.
Speak to your physiotherapist if you have any questions or concerns about the exercises you’re doing.
Your shoulder replacement should last for at least 10 years, and probably a lot longer. In more than seven in 10 people their shoulder replacement lasts for 20 years. However, in time 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 than your first operation. This is because your surgeon will need to remove your artificial joint before they can put a new joint in. It’s also possible that your upper arm bone (humerus) will become thinner over time. It usually takes you a little longer to recover from a repeat shoulder replacement than from the first operation.
Your surgeon will give you more information about a second joint replacement if you need one.
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- Shoulder and elbow replacement. Arthritis Research UK. www.arthritisresearchuk.org, accessed 21 July 2016
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Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, August 2016
Peer reviewed by Mr Roger M Tillman FRCS Orth, Consultant, Royal Orthopaedic Hospital Birmingham
Next review due August 2019
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