Shoulder replacement
Your health expert: Mr Henry Maxwell, Consultant Orthopaedic Surgeon
Content editor review by Liz Woolf, May 2021
Next review due May 2024
Shoulder replacement is an operation to replace your shoulder joint with an artificial joint. You can have a complete or partial shoulder replacement. You may have this surgery for shoulder joint damage, or wear and tear. This is usually from arthritis or an injury.
About shoulder replacement
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 (a type of strong tissue). The cartilage prevents your bones from rubbing together. Damage to the cartilage from an injury or arthritis can make your joint painful and stiff.
A new shoulder joint can help to improve your shoulder movement and reduce pain. Artificial shoulder parts are usually made of metal or plastic or a combination of the two.
The average age for people having a shoulder replacement is around 70. But many people are older than this when they have the surgery. An artificial shoulder joint will usually last for at least 10 years, often for much longer.
Types of shoulder replacement
There are several different types of shoulder replacement. Your surgeon will talk through which is the best procedure for you. This depends on:
- the condition of the muscles around your shoulder
- the stability of your shoulder and
- the strength of your bones.
There are four main types of shoulder replacement procedure.
Reverse shoulder replacement
This is the most commonly used shoulder replacement procedure. It gets its name from the fact that the surgeon switches round the positions of the ball and socket in your joint. A metal ball is attached to your shoulder blade, where your socket was before. And a new socket is attached to the top of your upper arm, where the ball was. The new ball and socket are fixed firmly in place with bone cement.
Total shoulder replacement
This is the second most common type of shoulder replacement procedure. If you have this type of operation, your surgeon will replace the ball at the top of your upper arm with a new metal ball. They’ll also replace the socket in your shoulder blade with a new plastic socket. As with the reverse replacement, the new ball and socket are fixed in place with bone cement.
Partial shoulder replacement (hemiarthroplasty)
In a partial shoulder replacement, the surgeon only replaces the ball at the top of your arm. The new metal ball will then move within the socket you already have.
Resurfacing shoulder replacement
This means replacing only the worn surfaces of the shoulder joint. This operation can also be partial or total. In partial resurfacing, the surgeon removes the damaged surface of the ball and places a cap over it. In total resurfacing, the surgeon removes the surface of the ball and the socket. They replace these with a cap over the ball and a plastic socket.
Revision surgery
A repeat shoulder replacement operation is known as a revision. You may need this because your implant has become loose or worn out. Overall, only one in 10 people needs a revision operation within 10 years of their operation. Even after 18 years, fewer than two in 10 patients overall need further surgery. But the risk is higher in men under 60.
Revision surgery can be more complicated than your first operation. Your surgeon has to remove your artificial joint before they can put in a new one. Also, removing more of the bone of your upper arm in a second operation can make it more likely to fracture. It usually takes you a little longer to recover from a repeat shoulder replacement than from the first operation.
Talk to your surgeon if you’d like more information about revision surgery.
Preparing for a shoulder replacement
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 anaesthetic. This visit gives you a chance to ask any questions you have about your admission. Your surgeon will tell you how to prepare for your procedure. If you smoke, they’ll ask you to stop. Smoking slows wound healing and increases your risk of a chest or wound infection. So, it can delay your recovery.
Before you go into hospital, think about how you’re going to get to and from hospital and manage at home afterwards. Make sure someone can take you to the hospital and bring you home after your operation. Plan to be away from home for between two and five days. Once you go home, you might want someone to stay with you to help out for a while.
In hospital
If you're having a general anaesthetic, you can’t eat or drink for about six hours beforehand. Your surgeon or anaesthetist will tell you exactly how long. It’s important to follow their advice.
Your surgeon will talk over what will happen before, during and after your operation. They’ll tell you how painful it is likely to be and about the painkillers you’ll have. Once you understand the procedure, and if you agree to have it, your doctor will ask you to sign a consent form.
What are the alternatives to shoulder replacement?
Surgeons usually only recommend shoulder replacement surgery if other treatments haven’t worked. These may include:
- physiotherapy
- non-steroidal anti-inflammatory medicines
- medicines for arthritis
- steroid joint injections
- local anaesthetic injections to relieve pain
- shoulder arthroscopy (keyhole surgery) to clean out the joint or remove any areas of inflamed joint lining
These are part of the range of treatments for osteoarthritis and rheumatoid arthritis.
If your surgeon thinks surgery is the best option for you, they’ll explain why.
What happens during a shoulder replacement?
Shoulder replacement is carried out by an orthopaedic surgeon. This is a doctor who specialises in bone surgery. They will have specialist training in the procedure.
You have a shoulder replacement with either a general or regional anaesthetic. A general anaesthetic means you’ll be asleep during the operation. A regional anaesthetic completely blocks pain from your shoulder. But you’ll be awake throughout the operation.
You may have both types of anaesthesia. Regional anaesthetic helps to ease pain after surgery. Your anaesthetist will talk to you about which type of anaesthesia is best for you. If you’re feeling very anxious, you might have a sedative as well as a regional anaesthetic.
Your surgeon will make a cut (incision) to reach your shoulder joint. This is usually down the front but may be at the side of your shoulder. At the end of the operation, your surgeon will close the cut with stitches or clips. The wound is then covered with a dressing.
What to expect after a shoulder replacement
You usually need to stay in hospital for two to five days after your operation.
If you have a regional anaesthetic, it may take several hours before you get feeling back in your shoulder. You’ll have pain relief to help with any discomfort. You may have injections, tablets, or patient-controlled analgesia (PCA) through a drip. With PCA, you have a button to press when you need more painkillers. This means you can control the amount of pain relief you receive. Tell your nurse if you’re in pain. Having good pain control will help you to recover.
Your surgeon may want you to wear elastic stockings and have injections of anti-clotting medication for a few days after your surgery. This is very common after many types of surgery and helps to prevent blood clots (deep vein thrombosis).
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.
A physiotherapist will visit you after your operation. They’ll guide you through exercises and ways to move your shoulder to help you recover. You’ll probably start these the day after your operation. This helps to prevent stiffness and will help your shoulder to heal. It’s very important that you follow the advice you’re given about how to move your shoulder.
You may have an X-ray taken of your new joint while you’re in hospital.
Your nurse should give you some advice about caring for your healing wounds before you go home. They may also give you a date for a follow-up appointment.
Having a general anaesthetic can affect your co-ordination and make it difficult to think clearly. You shouldn’t drink alcohol or operate machinery for 24 hours after your anaesthetic. You should also wait to sign important documents until you’ve recovered. You won’t be able to drive for a while after your shoulder operation.
Recovering from a shoulder replacement
It usually takes at least three to six months to make a full recovery from a shoulder replacement.
You’ll go home from hospital with a sling to support your arm and shoulder. For up to four weeks after the operation, you will need to wear it all the time, including at night. Your surgeon or physiotherapist will give you advice about when to wear your sling before you leave the hospital.
Your physio will give you an exercise plan to help your recovery. These will help to get your shoulder joint moving. And they’ll strengthen the muscles around your shoulder. It’s important to continue to do the exercises for as long as your physiotherapist recommends. These will help your shoulder to heal and may help you to recover more quickly.
Your physio will also tell you about some movements you shouldn’t do, including putting your arm behind your back. You should also take care not to use your arm to push yourself up out of bed or a chair. Within a few weeks, you should be able to do simple everyday tasks like washing and dressing.
Your surgeon may tell you not to lift anything heavier than a cup of tea for six weeks after your operation. Don’t do any heavy lifting or play any contact sports for at least six months.
Ask your surgeon for advice about returning to work and other activities. How quickly you can drive again will depend on how well you are recovering. You must be able to safely control your vehicle and perform an emergency stop. Always follow your surgeon’s advice. You should also contact your motor insurer before driving.
You will usually have painkillers to take home with you when you leave hospital. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist. Some people need painkillers for longer than others. If you have severe pain or it doesn’t get better, contact your surgeon for advice.
Side-effects of a shoulder replacement
Side-effects are unwanted effects you may have from any medical treatment. After shoulder replacement surgery you may have:
- discomfort or pain in your shoulder
- some difficulty moving your shoulder due to pain and weakness
- numbness around your scar
- swelling of your fingers
- numbness or tingling in your arm and fingers, especially if you’ve had a regional anaesthetic
These side-effects are usually temporary. They should gradually settle over four to six weeks.
Complications of a shoulder replacement
Complications are when problems occur during or after the operation. These complications don’t happen very often, but it’s good to be aware of them.
With any operation there is a risk of a reaction to the anaesthetic or excessive bleeding. You may also develop a blood clot. If this happens, it usually develops in a vein in the leg (deep vein thrombosis).
Complications that may occur around the time of shoulder replacement surgery include the following.
- Infection of the wound or joint. Your surgeon may give you antibiotics around the time of surgery to help prevent this.
- Fracture (breakage) of your upper arm bone either during or after the operation.
- Accidental damage to nerves, muscles and blood vessels around your shoulder. Over time, some nerve injuries may get better and some even recover completely.
There are also possible longer-term complications, including:
- instability of your shoulder joint, which may even move out of its socket (dislocate)
- loosening of the replacement parts, especially the new ‘socket’ part in the shoulder
In some cases, you may have to have a further operation on your shoulder if you develop complications. If you want to know more about possible complications, ask your surgeon.
Sepsis (adults)
Sepsis is a life-threatening complication that can develop if you get an infection. Sepsis is a medical emergency. Call 999 or go to A&E immediately if you have any of the following symptoms.
- Slurred speech, confusion, difficulty making sense.
- Extreme shivering or muscle pain.
- Passing no pee (urine) during a day.
- Severe difficulty breathing, feeling breathless, or breathing very fast.
- It feels like you’re going to die.
- Skin changes such as your skin looking blue, pale or blotchy, or a rash that does not fade when you roll a glass over it.
Looking for physiotherapy?
You can access a range of treatments on a pay as you go basis, including physiotherapy.
To book or to make an enquiry, call us on 0370 218 6528∧
It’s natural to have pain after an operation. But everyone is different so it’s not possible to say exactly how you’ll feel. You’ll be given painkillers straight after your operation. You’ll usually have some to take home too. There’s more about pain after shoulder replacement surgery in our aftercare and recovery sections.
It usually takes three to six months to recover from this type of shoulder surgery. But you might find your shoulder function continues to get better for up to a year. There is more about recovery in the section ‘Recovering from shoulder replacement’.
Shoulder replacement is generally very successful, with implants lasting as long as 20 years. As with any joint replacement, the implant can loosen or wear out over time. But overall, only one in 10 people needs revision surgery within 10 years of their operation. For more information see the section ‘Types of shoulder replacement’.
Osteoarthritis
Osteoarthritis is the most common form of arthritis, affecting over eight million people in the UK. It affects your joints, making them stiff and painful.
Physiotherapy
Rheumatoid arthritis
Rheumatoid arthritis is a condition which causes pain, swelling and stiffness in your joints.
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- Shoulder joint replacements. Patient. patient.info, last updated July 2016
- The Shoulder. Encyclopaedia Britannica. britannica.com, accessed May 2021
- Glenohumeral arthritis. Medscape. reference.medscape.com, last updated September 2019
- Public and patient guide to the NJRs 14th annual report, 2017: shoulder replacement edition. Healthcare Quality Improvement Partnership. njrcentre.org.uk, published February 2018
- Craig RS, Lane JCE, Carr AJ, et al. Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population based cohort study using hospital episode statistics for England. BMJ 2019; 364:1298, doi.org/10.1136/bmj.l298
- Personal communication. Mr Henry Maxwell, Consultant Orthopaedic Surgeon, June 2021
- Shoulder and elbow replacement. Versus Arthritis. versusarthritis.org, accessed May 2021
- Anaesthesia explained. Royal College of Anaesthetists. rcoa.ac.uk, published March 2021
- Oxford Handbook of Adult Nursing. 2nd ed. Oxford University Press. oxfordmedicine.com, published June 2018
- Nerve blocks for surgery on the shoulder, arm or hand. Royal College of Anaesthetists. rcoa.ac.uk, published February 2020
- Patient Guide for Total Shoulder Replacement. Royal Orthopaedic Hospital. roh.nhs.uk, accessed June 2021
- Shoulder hemiarthroplasty technique. Medscape. emedicine.medscape.com, last updated February 2021
- Frequently asked questions. Royal College of Anaesthetists. rcoa.ac.uk, accessed May 2021
- Common postoperative complications. Patient. patient.info, last reviewed November 2020
- You and your anaesthetic. The Royal College of Anaesthetists. rcoa.ac.uk, published February 2020
