What is a Total Shoulder Replacement?
Shoulder replacement surgery is a treatment option for patients whose shoulder arthritis has become so severe that they cannot tolerate the pain and functional impairment they experience. Shoulder replacement surgery is usually recommended only after a patient has tried nonoperative treatments for the shoulder arthritis.
There are many different types of shoulder replacements. The most common shoulder replacement done in America and Europe is called an anatomic total shoulder. This surgery replaces the ball of the shoulder with an artificial ball and resurfaces the socket of the natural socket with an artificial component. Most orthopedic surgeons will use the term “total shoulder” interchangeably with the term “anatomic total shoulder”. This type of total shoulder is dramatically different from reverse shoulder arthroplasty (see second tab) and different from Shoulder Hemiarthroplasty (see third tab).
Total shoulder replacement is a very gratifying operation for patients. Most patients experience a dramatic improvement in their shoulder’s flexibility. They generally notice a profound decrease in shoulder pain.
Improvements in Technology
I don’t believe I saw a shoulder replacement performed when I was in medical school in the 1970s. Shoulder replacement surgery was rare in those days. It was rare for good reason: shoulder replacements didn’t work very well in the early days. Unfortunately, that history has branded total shoulder replacement with an unwarranted reputation. There are some practitioners that still believe that total shoulder replacement does not work very well.
I performed my first total shoulder replacement in 1990. I’m not sure exactly how many I have done, but I think I’ve done between 600 and 800 total shoulder replacements. I am grateful to the practitioners, researchers, companies and local representatives that have worked so hard for so long to refine what is today a predictable, reliable, and worthwhile operation.
Total shoulder replacement is most commonly performed for the diagnosis of osteoarthritis of the shoulder. It is also utilized to treat other forms of arthritis in the shoulder that have reached a point such that nonoperative treatment is unacceptable.
Total shoulder replacement surgery is done in a hospital operating room. The patient is generally anesthetized with a nerve block called a “scalene block” along with a general anesthetic. Once I begin operating, it usually takes me about two hours to do a typical total shoulder replacement. I do the surgery. I’m the only physician present during my surgeries (excluding the anesthesiologist). I do not utilize a nurse practitioner or physician assistant when I perform surgery and I perform the surgery from start to finish. I also help position the patient on the bed before the surgery starts.
When the surgery is completed a patient usually spends about one hour in the recovery room. Then they go to a regular hospital bed. Most will spend two nights in the hospital. It’s very rare for a person not to return to their home after their two-night hospital stay. A few patients will need to go to a rehabilitation facility, but most do not. Unless there is a unique factor that governs the patient’s hemoglobin level, I do not transfuse patients after shoulder replacement surgery. They usually don’t need it.
On the day of surgery most patients are very comfortable. The nerve block used to eliminate pain during surgery generally lasts for the remainder of the day of surgery. Patients may experience the worst pain during the 24-hours after the nerve block wears off. That pain is severe enough to require regular narcotic pain medication. During the second postoperative day, the pain diminishes to a remarkably low level.
First Few Weeks
As soon as the arm awakens from the anesthetic, it’s okay to begin using it. A sling is used only if the patient wants to use the sling. A total shoulder replacement is ready for use for many day-to-day tasks from the very beginning of the recovery. Therapy begins the morning after surgery, and after the patient leaves the hospital they do home exercises for the first 2 weeks. Patients are very confident about how to do the exercises as a result of the training they receive while in the hospital. It is not necessary to go to a physical therapist, nor is it necessary for a physical therapist to come to you in most cases during weeks one and two of recovery.
I prescribe narcotic pain medication for the patient to use at their discretion to control pain. Generally a person is able to diminish their narcotic pain medication use very quickly. It is not unusual to have a need for narcotics only at bedtime by the 2nd week postoperative mark.
Within days of their surgery, most patients can bathe themselves, put on and take off their clothes, and tend to all personal hygiene tasks independently. I allow patients to drive when they are free of narcotics. I find that many online references imply that driving cannot take place for months. I have not found that to be a necessary restriction.
I use surgical glue instead of stitches on the skin when I perform shoulder replacement surgery. The surgical glue is waterproof. This diminishes the chance of infection. It eliminates the need for a bandage. From the very beginning, it is okay with me for a patient to shower and bathe as they normally would. Because there is no bandage, you will note a lot of bruising and discoloration around the surgical wound. This is normal.
The entire operated extremity develops swelling after the surgery. A lot of bruising usually appears in the first few days; that bruising will progress down the arm and usually involve part of the forearm. Some of the bruising may be evident for up to weeks after the surgery.
The Two Week Mark
About two weeks after the surgery date, I examine the patient in the office. If all seems appropriate, I then recommend outpatient physical therapy. That therapy is usually prescribed by me at a frequency of about three times per week. There are many fine physical therapy locations in the Greenville area. I have experience with many. I have compiled these facilities into a list that I can provide for you. Everyone on my list of physical therapy locations represents a facility that has rehabbed shoulder patients for me before and has passed my muster. I will send you there with a detailed prescription that outlines what should and should not be done to your new shoulder.
Six Weeks After Surgery
If all is healing well at six weeks, all restrictions on range of motion and exertion of the shoulder are lifted. At this point most patients are very happy with their new shoulder. They’re able to do things that they haven’t been able to do for years. For example, they may be able to reach back and put a belt through a loop in the small of their back. Men are able to put a wallet in their pocket for the first time in a long time. I expect a patient to be able to use her new shoulder to brush the back of her head and hold a hairdryer. It’s a lot of fun to watch a patient’s joy as he regains abilities that he thought were gone forever.
Three Months After Surgery
I find that most patients feel like they are fully recovered three months after surgery. That is not the case, however. The muscles that had been restricted from use for years and years will continue to gain strength until about one year following surgery.
When a patient is fully recovered from surgery, I’ll usually recommend that they follow-up about once a year.
The Life of a Shoulder Replacement
A well cared-for total shoulder should be expected to last about 15 years. There is wide variation in the durability of total shoulders. It would be a mistake for anyone to think that fifteen years is guaranteed; however, many of the total shoulders I did over 20 years ago are still functioning very well. Some of the shoulders I’ve done have failed within the first few years.
If you think you may someday want to have total shoulder surgery performed, I encourage you to explore the FAQs: