Before any surgery, most people have many questions and concerns, especially if this is their first time. They may want to ask their doctor things like how long it will take to recover. What are the risks? How much will it cost? Is it something you do in a hospital or as an outpatient in a doctor’s office? Are there any complications that I should be aware of?
In particular, shoulder replacement surgery may trigger some fear because it is a joint we use for almost everything. But if you’re a candidate for shoulder replacement surgery, it is because you have severe pain, and maybe this pain is the one deciding for you.
You don’t want to base your medical decisions on doubts or transient emotions. Thus, the best thing you can do is talk to your doctor and read as much as possible about the type of surgery you’re about to get.
Shoulder replacement surgery is not a simple procedure; it requires a complete understanding of the benefits and risks to make an informed decision. In this article, you will find everything you need to know about shoulder replacement surgery to guide your choices and understand your doctor when you’re communicating your concerns.
What is shoulder replacement surgery
Shoulder replacement surgery, or shoulder arthroplasty, is a surgical procedure performed to relieve pain and improve the quality of life for patients with damaged or painful shoulders triggered by damage in the joint surface. The procedure is performed to replace the ball and socket joint of the shoulder with a prosthetic joint. Shoulder replacement surgery can be used to treat many conditions that cause shoulder pain, including arthritis, fractures, and rotator cuff tears.
It is a common procedure performed by orthopedic surgeons and other physicians. They would replace the damaged or missing bone and cartilage with metal or plastic implants. The surgery aims to improve the function of the shoulder joint and can be performed using a traditional open approach or through minimally invasive techniques.
If your problem is outside the joint, it is not a shoulder replacement surgery. For instance, if your doctor is going to repair the rotator cuff without dealing with the joint itself or replacing joint structures, this is another surgery with different steps, procedures, benefits, and risk factors.
⇒ Now, let’s discuss types of shoulder replacement.
Types of shoulder replacement surgery
Since shoulder replacement surgery is done in a very complex area that includes two different joints, there are different types and techniques your doctor can use depending on the location, severity, and extent of the damage.
There are different types of shoulder replacement surgery or arthroplasty. They are:
1. Total shoulder replacement surgery: This type of shoulder replacement is performed when a patient has arthritis in the shoulder joint. It involves replacing the ball and socket joint with an artificial one. As the name implies, the glenohumeral articulation is completely replaced with prosthetic materials which are cemented or pressed to fit in place.
2. Reverse shoulder arthroplasty: This type of shoulder replacement is used to treat patients who have more advanced damage due to osteoarthritis and other diseases. It also involves removing the ball and socket joint and replacing them with a new pair. But instead of placing the socket on the shoulder bone and the ball on the humerus, doctors will place the prosthetic parts in the opposite direction. This approach can also be used when total shoulder replacement surgery fails.
3. Stemmed hemiarthroplasty: It can sometimes happen that only the ball of the humerus is damaged. For example, after enduring a fracture, it can be broken while the glenoid cavity is intact. After evaluating the damage, the doctor may recommend stemmed hemiarthroplasty to replace only the ball of the humerus and leave the healthy socket intact.
4. Resurfacing hemiarthroplasty: This is another option to replace or fix the ball of the humerus while leaving the glenoid cavity intact. In this case, doctors won’t replace the whole bony structure of the ball. They will only scratch and remove the damaged surface and install a prosthetic surface in its place. This is not strictly a replacement, which is why it is called resurfacing, and it is done when the ball is not severely damaged, and the doctor wants to preserve the humeral head.
As noted, every type of shoulder replacement surgery has its features and recommendations. It is not about which one is better but which is recommended according to your condition. The only one who can make the distinction is a skilled orthopedist.
Costs and expenses
The price of this surgery depends on the type of procedure you’re having, the approach, the hospital or clinic you visit, and ultimately on your doctor. That’s why we use price ranges instead of a fixed prices.
- Shoulder replacement surgeries, including total shoulder replacement and reverse shoulder replacement, will cost somewhere between $15,000 to $50,000.
- Hemiarthroplasty procedures, including stemmed hemiarthroplasty and resurfacing hemiarthroplasty, will cost somewhere between $15,000 and $25,000.
You should discuss with your doctor about insurance policy and to be sure about whether hospital stay and other expenses are included.
Are you a candidate for shoulder replacement surgery?
Shoulder replacement surgery is typically used for patients with pain, a limited range of motion in the shoulder, and significant pain. The surgical procedure may be done alone or in combination with other procedures.
The indications for shoulder arthroplasty include:
-
- Painful arthritis of the shoulder joint
- Rheumatoid arthritis
- Fractures of the shoulder
- Osteoarthritis
- Rotator cuff arthropathies
- Osteonecrosis (Avascular necrosis)
Shoulder arthroplasty surgery can also be performed when other conservative treatment methods have failed, including pain medications, physical therapy, injections, and others.
There are also specific indications for each procedure. For instance:
-
- Total shoulder replacement surgery: It is typically advised when patients have intact rotator cuff tendons and if they suffer from severe arthritis with bone-on-bone rubbing.
- Reverse shoulder arthroplasty: It is recommended instead of total shoulder replacement when the rotator cuff tendons are completely torn or when a previous total shoulder replacement surgery has failed.
- Stemmed hemiarthroplasty: This procedure is recommended when the glenoid surface is healthy, and only the ball is affected by a fracture or arthritis. It can also be effective in the case of rotator cuff injuries.
- Resurfacing hemiarthroplasty: This procedure is recommended when the glenoid surface and most parts of the ball are healthy, and only the surface of the humeral ball needs to be replaced. It is considered when doctors consider it appropriate to preserve the humeral bone.
Benefits vs. risks of shoulder replacement surgery
Before undergoing shoulder replacement or hemiarthroplasty, your surgeon will discuss the risks and benefits of the procedure with you. Before the surgery, be sure to ask any question you have, and take notes if possible to answer any doubt that will come.
» Benefits of shoulder replacement surgery:
The procedure can provide relief from pain and restore function to the affected shoulder. It also reduces the risk of further injury and improves the quality of life. It has a very high rate of success, and there are different techniques to try when it is not so.
» Risks of shoulder replacement surgery:
The risks associated with shoulder replacement surgery include nerve damage, blood clots, infection, and a dislocation of the implant. We will explain these and other risks when talking about complications.
Medical evaluation before shoulder replacement surgery
Patients must be carefully selected before they undergo any of these procedures. The medical evaluation includes a thorough examination of the affected shoulder.
The surgeon will need to determine the amount of bone loss, joint space, and soft tissue damage. They will also need to determine if the patient has osteoporosis or any other conditions that may affect the outcome of the surgery. It is also fundamental to make sure that surgery is not dangerous for you.
Thus, you will probably need the following exams:
-
- A physical exam to measure stability, strength, range of motion, and other aspects of the shoulder joint.
- A simple radiography to evaluate the shape of the bone ends, the joint space in-between, and the amount and shape of cartilage.
- Other tests when there are further doubts about the nervous and soft tissue components, including a CT scan and an MRI.
- A set of preoperative tests to determine if your cardiovascular and respiratory systems can withstand the stress of surgery.
Complications
All medical procedures have their own benefits and risks. Unexpected complications can compromise the outcomes. In shoulder replacement surgery, the most common include:
1. Infection: Wound infection is always a possibility after surgery. This is the most likely complication, especially if you don’t follow instructions in terms of wound cleaning and taking antibiotics. In most cases, they are minor infections that are treated with antibiotics. In severe cases, the inflammation can even compromise the outcome of the surgery and damage the prosthetic joint.
2. Prosthesis problems: The prosthesis can also loosen or wear down. In some cases, they could even dislocate or fall out of place. These complications are more common if you’re not careful with the activity recommendations the doctor gives you after surgery. A revision procedure can solve the problem in most cases.
3. Nerve damage: Doctors are very careful when performing shoulder replacement surgery. However, many structures go through the shoulder joint, and sometimes patients have anatomical variations that increase the risk of nerve damage or another type of tissue damage. Patients can experience different motor and sensory abnormalities when nerves are damaged during surgery.
Recovery time after shoulder replacement surgery
Patients are typically able to go home the day after surgery. The hospital stay is usually no longer than three days, and throughout that time, doctors and their nurses will ensure that you don’t suffer the immediate complications of the surgery. When everything is clear, you will be able to go home and start your recovery outside of the hospital.
After this surgery, you should be able to resume most normal activities after two to six weeks. During this time, you will need a sling to protect your joint. As noted, you can start your normal activities in only 15 days or may need more than one month to recover. It all depends on the type of surgery you underwent and its complexity.
You may experience some pain and stiffness during the first days, so you’ll be given pain medication to control your symptoms. Patients may also experience swelling and bruising after the surgery. Report them if they are very severe and appear suddenly and accompanied by pain.
You’ll also need to follow a post-surgical rehabilitation program, usually performed by a physical therapist who visits your home and guides you every time. The physical therapy will be programmed soon after completing the surgery, and you must complete all the programs, including any exercise that is recommended to do by yourself.
During this recovery period, it is also essential to keep in mind these recommendations:
-
- Don´t push your body to stand from a chair or the bed
- Follow the exercises prescribed for you to the letter
- Don’t push yourself too much. Report any shoulder pain you experience while performing an exercise to ensure it is normal.
- For 2 to 4 weeks, do not lift anything heavier than 200 or 300 grams
- Avoid contact sports and anything that requires repetitive handwork
- Avoid stretching your hands excessively behind your body or to the sides
- Ask for assistance before and after surgery. Part of your surgery planning should include asking your family or a friend to assist you during the first weeks of recovery or until you’re clear to do house chores on your own.
Conclusion
In conclusion, there are many shoulder replacement procedures available to the patient. There are surgical procedures that involve removing and replacing the whole joint. Others remove the joint partially and leave some parts intact. You can even have resurfacing surgery, which involves replacing only the damaged surface of the joint while leaving the healthy surface intact.
Each surgery variant has its own indications, recovery time, costs, benefits, and risks. But what they all have in common is that they are complex procedures that a very skilled surgeon should perform. This is an important surgery that can sometimes be very difficult and stressful for your body and may require a lengthy recovery period. Thus, the patient must be fully aware of all the risks before they are under the scalpel.
There are risks involved, as in every medical procedure, but shoulder replacement surgery is safe and has a very high success rate. It has improved the quality of life in many people with chronic shoulder pain that does not improve with any other conservative method and can also work for you.
If you have shoulder pain and want to know more about shoulder replacement surgery, visit an orthopedic surgeon and ask every question you have about this topic before deciding anything.