Anatomical Shoulder replacement

This leaflet will advise you on undergoing a total or half (the ball only) shoulder replacement and outline the recovery of your shoulder following the surgery. 

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Why do I need this operation? 

Your shoulder is a ball-and-socket joint made up from the head of your arm bone and shoulder socket which is part of the shoulder blade. Your shoulder has developed arthritis which means the cartilage has worn out, causing pain and stiffness. Most commonly cause for this is genetic (i.e. some people are prone to developing arthritis than others and it may be their parents suffered from the same condition), but previous injury and inflammatory conditions such as rheumatoid arthritis may also lead to degeneration of the joint. Your shoulder has now got to a point where non-operative measures (e.g. anti-inflammatories and steroid injections into the joint) are no longer controlling symptoms and function is deteriorating. A shoulder replacement will give you the best chance of having a pain-free functional shoulder. Once fully recovered you should expect to a similar or slightly better range of movement than before surgery. If you look after the new shoulder the current evidence suggests it could last 15 years or more. 

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The operation 

The aim of the operation is to replace the diseased joint surfaces with artificial prostheses. The top of the humerus (the ball part of the joint) is replaced with a strong alloy metal or hard composite. The side of the scapula (the socket part of the joint) is replaced with a piece of durable, moulded plastic. There are two types of operation -replacing both the ball and socket is called a "total shoulder replacement"; replacing just the ball is called a "shoulder hemiarthroplasty". Your surgeon will select which operation is most appropriate for you depending on the nature of the condition and your age. On occasions the surgeon will make the decision during the operation. The operation will be done through a vertical incision over the front of the shoulder. 

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Potential complications 

Unfortunately any operation has a chance of having a complication. Fortunately the chance of having a complication is small (<5%) and having a significant complication that will have a negative effect on the outcome of surgery is even smaller (<1%). The following are specific complications associated undergoing a shoulder replacement: 

Infection superficial wound infections can often be treated with a short course of antibiotics but ideally we would like you to contact the surgical team prior to your GP starting any medication. Deep infections within the joint are rare but would require you to come into hospital to have the shoulder washed out and go on intravenous antibiotics. The worst case scenario is that the replacement has to be removed and a new one put in which is sometimes done in two stages about 3 months apart 

Stiffness the majority of your rehabilitation involves resolving the stiffness created by surgery and getting back the original range of movement after 3 months you should have a good functional range of movement and optimal movement will take between 9 months and 1 year. 

Fracture - occasionally, when the prosthetic components are being inserted the can fracture. Usually this is not a major problem and the surgeon can fix the fracture during the operation. It may be that your rehabilitation is slowed down. 

Dislocation this may indicate if one of the tendons in the shoulder has failed. It may be that it can be reduced by manipulation alone but most likely will need a further operation to stabilize it (especially if it happens in the first few weeks). If the dislocation is recurrent the shoulder replacement may need a revision to a different type of prosthesis. 

Nerve injury the surgeon has to work close to the main nerves going to the arm during the surgery. Sometimes nerves can get compressed or squashed during surgery which will present with numbness and weakness but this is likely to resolve within a few days. Permanent nerve injury is exceptionally rare but would lead to significant disability. 

Loosening - the prosthesis will be embedded solidly in the bone following surgery but after many years of use the components can become worn and loose. At this point the shoulder may start to become painful and loose range of movement. Normally this does not happen until after ten years, if it happens earlier there may be another problem with the replacement. 

Tendon failure the shoulder replacement relies (as does a normal shoulder) on a special group tendons called the rotator cuff. Your surgeon will examine the tendons carefully both before and during the operation to make sure they are competent. Occasionally after surgery (usually after several years) that the tendons tear and this could significantly limit the function of the shoulder 

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The shoulder joint after replacement surgery 

Length of hospital stay: Normally 1 to 2 days 

Arm immobilisation: 4 weeks in sling or brace (see image) 

Total recovery period: 9 to 12 months 

Return to driving: 6 to 8 weeks 

Return to work: Desk based job - 4 to 6 weeks Manual job - 4 months 

Return to sports: Non-contact from 6 months Contact/overhead from 9 months 

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