Table of ContentsView AllTable of ContentsWhat Is Total Shoulder Replacement Surgery?Purpose of Total Shoulder Replacement SurgeryHow To PrepareWhat To Expect On The Day Of SurgeryRecovery
Table of ContentsView All
View All
Table of Contents
What Is Total Shoulder Replacement Surgery?
Purpose of Total Shoulder Replacement Surgery
How To Prepare
What To Expect On The Day Of Surgery
Recovery
Total shoulder replacement, also known as total shoulder arthroplasty, is a procedure where portions of the bones in the shoulder joint are removed and replaced with artificial implants. It helps restore the function and mobility of the shoulder joint, while also reducing pain. This surgery may be recommended for a variety of conditions, such as degenerative joint disease (osteoarthritis) or severe fractures of the upper arm bone (humerus).
Some people may need a reverse total shoulder replacement, where the anatomy of the ball and socket joint is reversed with the artificial implants. Surgeons select the reverse approach for patients with badly-injured rotator cuffs, arm weakness, severe arthritis paired with arotator cuff tear, or a failed total replacement surgery.
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The shoulder joint is made up of three main bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). These three bones are connected with ligaments and cartilage, which protects the ends of the bones where they meet. The head of the humerus meets the scapula at the socket (glenoid), forming the joint that allows range of motion of the upper arm and shoulder.
In a total shoulder replacement, the damaged head of the humerus and the surface of the glenoid are removed. Then, artificial implants are placed to make the joint area smooth and functional, mimicking the size of the patient’s bone that was removed. By removing the damaged portions of the bone and cartilage, patients experience less pain and increased range of motion.
In most cases, this surgery is an inpatient and elective procedure. Generally, patients stay in the hospital for two to three days following the procedure.
Contraindications
Total shoulder replacement is typically performed on older adults. Prior to seeking out surgical options, patients may undergo conservative treatments such asnonsteroidal anti-inflammatory drugs(NSAIDs), steroid injections, or physical therapy. There are some situations that would make a patient a poor candidate for this type of surgery:
Causes of Shoulder Pain and When Is It Serious?
Potential Risks
As with any surgery, there are risks for potential complications associated with having this type of procedure, which include:
The following conditions are examples of causes for shoulder pain that could require surgery:
How Do I Know If I Need a Total Shoulder Replacement?The orthopedic surgeon will do a variety of tests to determine if a patient is a suitable candidate for total shoulder replacement surgery. A physical exam of the shoulder is performed to determine the range of motion and stability, and to assess the strength of the joint. X-rays will be taken to determine the severity of arthritis, possible fractures, bony overgrowth areas, or cartilage trapped or floating in the joint. An MRI may be done to determine the quality of the bone. Depending on other patient conditions, additional tests may be required.
How Do I Know If I Need a Total Shoulder Replacement?
The orthopedic surgeon will do a variety of tests to determine if a patient is a suitable candidate for total shoulder replacement surgery. A physical exam of the shoulder is performed to determine the range of motion and stability, and to assess the strength of the joint. X-rays will be taken to determine the severity of arthritis, possible fractures, bony overgrowth areas, or cartilage trapped or floating in the joint. An MRI may be done to determine the quality of the bone. Depending on other patient conditions, additional tests may be required.
Some patients will undergo a nerve block (interscalene block) prior to the surgery that will numb the shoulder and arm for the procedure. Even with a block, patients will generally still be asleep for the surgery because they will also receivegeneral anesthesia.
Location
Typically, patients have total shoulder replacement surgery in a hospital setting. When entering the operating room, the surgical team will ask the patient to move over to the surgical bed, which sits up like a beach chair, for the procedure. Sometimes surgical team members wear hood coverings to prevent possible contamination during the procedure. Patients may be surprised to see people in full protective gear as they enter the operating room.
What To Wear
It’s important to arrive on the day of the surgery wearing a button-down shirt or something loose enough to fit over a sling with the arm close to the chest or abdomen. A button-down shirt makes it easier to put a shirt on after the surgery, especially if the arm is still numb from the anesthesia block. Comfortable pants and shoes are a good choice, and potentially a sweater or jacket because the hospital can be cold.
Food and Drink
Medications
Patients should provide a thorough list of current medications and alert the surgeon to any changes in or skipped medications on the day of the surgery. The surgeon will determine if medications that cause increased bleeding should be continued or stopped depending on the condition of each patient.
What To Bring
It’s important to bring a photo identification and insurance cards on the day of the surgery. An overnight bag with any belongings (such as glasses or a phone charger) should be available for patients staying a few days in the hospital.
Before the Surgery
In the preoperative area on the day of the surgery, a nurse will assess your vital signs, weight, pregnancy status, and blood sugar level. You will remove your clothes and jewelry, and change into a surgical patient gown that allows the surgeon to easily access the shoulder. The nerve block will be performed prior to arriving in the operating room.
During the Surgery
The patient will be rolled on a stretcher into the operating room and asked to move over to the surgical bed. The anesthesia providers will attach monitors to your back and chest on the nonoperative side to record vitals signs. The patient will be put to sleep with general anesthesia and a breathing tube will be inserted. Once the airway is safely established, the surgical team will begin positioning the patient into a sitting position. The surgical nurse will use an antiseptic solution to prepare the shoulder for surgery.
The surgical team typically consists of anorthopedic surgeon, assistant to help hold retractors, surgical nurse, surgical technologist, and anesthesia providers. There are different types of assistants depending on the facility, such as an orthopedic resident, physician’s assistant, nurse practitioner, or first assistant nurse or tech.
The steps of the surgery are as follows:
The surgery typically lasts two hours. Once the dressings and shoulder sling are in place, the patient will have the breathing tube removed.
After the Surgery
The patient will be brought out of surgery to the post-anesthesia recovery unit, where they will recover for a few hours. As with any surgery, there is some pain associated with the procedure. Patients who had a nerve block may not experience pain until later when the block wears off.
Once the patient is more awake, they will be given liquids to see what they can tolerate before moving to solid foods. A postoperative X-ray may be taken the day of the surgery or the following day to get final views of the implants.
Most patients will stay in the hospital for two to three days, depending on how well they are feeling following the procedure and how much help they have when they return home.
Healing
The surgical wound will be covered with a dressing. If the dressing is waterproof, it may be possible to shower. Surgical wounds should not be submerged under water until fully healed and closed to prevent infection. The surgeon will provide postoperative instructions, depending on the dressing applied, about whether or not to shower or change the dressings. Some surgeons prefer for patients to wait until they are seen in the office for their first post-surgery visit before removing the dressings.
Long-Term Care
Physical therapyis an essential and standard step in the process to rehabilitate the shoulder and regain function, strength, and mobility. For patients with desk jobs, the potential to return to work is about two to three weeks. Patients with heavy or physical labor will be out of work for around four months.
Around six weeks after the surgery, patients will be able to do light activity with the shoulder. Range of motion and strength will steadily increase with proper physical therapy over the following months, with significant improvement markers at 3, 6, and 12 months.
Each surgeon has a different preference for when their patients should start physical therapy after the procedure. It’s a good idea to have a discussion prior to the surgery about when to start physical therapy with your surgeon.
Physical Therapy Exercise After a Total Shoulder Replacement
A Word From Verywell
Total shoulder replacement surgery can be life-changing for people who have experienced years of debilitating shoulder pain or have limited range of motion. While the initial surgery can take some time to recover from, there are many benefits to using the shoulder without pain.
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Shoulder joint replacement.Hospital for Special Surgery.Shoulder replacement surgery.University of California San Francisco Health.Recovering from shoulder replacement surgery.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Shoulder joint replacement.Hospital for Special Surgery.Shoulder replacement surgery.University of California San Francisco Health.Recovering from shoulder replacement surgery.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons.Shoulder joint replacement.Hospital for Special Surgery.Shoulder replacement surgery.University of California San Francisco Health.Recovering from shoulder replacement surgery.
American Academy of Orthopaedic Surgeons.Shoulder joint replacement.
Hospital for Special Surgery.Shoulder replacement surgery.
University of California San Francisco Health.Recovering from shoulder replacement surgery.
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