Shoulder Replacement
What is a shoulder replacement? Why should I have one?
Typically a shoulder replacement is an effective solution for shoulder arthritis, some types of fractures or massive irreparable rotator cuff tears that have not responded to non-surgical treatments for six months or longer.
During the procedure, the surgeon removes the damaged humeral head (the ball) and the glenoid (the socket of the shoulder joint) and replaces them with artificial components forming an artificial ball and socket joint to restore smooth and pain free movement.
“Shoulder pain that remains untreated can result in devastating quality of life and sleep,” says Dr Philip Markham, Specialist Joint Surgeon at SJS Orthopaedics Wollongong, Gosford and Sydney.
“Recovery after a shoulder replacement can be painful for the first two weeks, but is usually managed well with prescription analgesia, and a sling is required.
“But a shoulder replacement is not as painful as a knee replacement, to put it into perspective, and does not usually require more than a single night in hospital.
“The initial pain will certainly be better than months or years of extreme pain, loss of movement, poor sleep, arm weakness and the inability to do the things you used to do.”
He says for some people, shoulder arthritis is so severe it can prevent their ability to earn an income.
“For others it’s about getting a good night’s sleep again, lifting the grandkids or being able to be independent with day to day tasks like cleaning or carrying the shopping.”
He says if pain, weakness and stiffness persists for more than 6 months, despite physiotherapy, anti-inflammatories and other non-surgical treatments, it’s time to see the shoulder surgeon.
“If patients wait too long for a shoulder replacement, they risk developing more disability and loss of quality of life.
Dr Markham says it’s also important to be assessed by an experienced shoulder surgeon earlier rather than later, as there are a range of interventions that may be applicable early in a patient’s course of treatment.
“‘Some patients are not suitable for surgery. For instance, elderly patients with significant comorbidities are at increased risk of complications. Other people not suitable include patients with an active infection or neurological pathologies.”
“With modern orthopaedic implants and anaesthetic techniques age is becoming less of a barrier to undergoing successful shoulder replacement surgery. I have performed many successful procedures on patients aged in their 80s.
“At the other end of the spectrum the concern with younger patients is the possibility of component failure after 20 years, consequentially surgeons often prefer to wait until patients are aged in their 50s to perform surgery.
“There are more challenges with a revision procedure, and important considerations for surgeons typically include the quality of the remaining bone; the impact of the current shoulder function, the patient’s ability to participate in rehabilitation as well as the patient’s overall health.”
“However if there is a shoulder replacement prosthetic failure causing pain and loss of function, or there is infection, it is certainly possible to do revision surgery with good results and function in the large majority of cases.”
“About 95% of shoulder replacements today continue to function well 10 years after surgery, and that will likely be close to 85% at 20yrs” says Dr Markham.
https://aoanjrr.sahmri.com/documents/10180/1579982/AOA_NJRR_AR23.pdf
Although shoulder replacements aren’t as common as hip or knee replacements, they offer the same success in returning function and relieving pain in an aching shoulder joint just as a replacement does for a hip.
In Australia in 2022 there were 9,003 shoulder replacements performed, an increase of 227% since 2008.
“It is particularly beneficial for patients with severe arthritis AND rotator cuff tears, as a procedure that effectively treats both conditions,” says Dr Philip Markham.
Currently reverse shoulders make up over 80% of all new total shoulder replacements implanted in Australia and represent 70.9% of all existing total shoulder replacements.
This option is best suited for younger patients with good bone quality. The short stem and mid head shoulder replacements are bone preserving and have a variable angle interface to maximise and restore biomechanical function and have a low revision rate (approx 5% at 10yrs).
Common side effects of shoulder replacement surgery include
- Swelling
- Bruising
- Stiffness
- Pain that settles after a day or two and is managed with pain medications and post-operative care.
- Limited range of movement
Less common complications include:
- Infection that requires antibiotics and in severe cases surgical intervention
- Blood clots that can lead to pulmonary embolism if the clot travels to the lung
- Nerve or blood vessel damage, which can result in temporary or rarely permanent changes in sensation, movement or circulation.
- Risks with anaesthesia
- Implant loosening (over time leading to revision)
- Dislocation (usually associated with a fall or implant wear)
The golden rule for driving is when you are no longer wearing a sling, and this is generally after 4 to 6 weeks, or as directed by Dr Markham.
Strong pain medication is not usually required after 1 or 2 weeks, except sometimes at night, but should be ceased prior to a return to driving.
It’s OK to shower with the waterproof dressing intact. The dressing will usually be removed after about 2 weeks from surgery.
You will be asked to wear a sling for four to six weeks after surgery.
Adhering to post-operative instructions, attending your follow-up appointments and participating actively in rehabilitation treatment will help mitigate any potential side effects of shoulder surgery.
