Shoulder replacement surgery is a safe and effective procedure to restore comfort and eliminate motion restrictions, and disability. Recovery from a shoulder replacement requires the patient’s commitment to proper and extensive post-op rehab to achieve the full benefits from this surgery.
Generally, surgery is recommended when people with severe shoulder pain cannot control their pain with oral medication, injections, rest and adjustment of shoulder activity.
People who would benefit from shoulder replacement surgery include:
- Those who have severe shoulder pain that interferes with every day activities.
- Moderate to severe joint pain while resting, which at times is severe enough to interfere with good sleep.
- Loss of motion and/or weakness in the shoulder.
- Failure of the patient to improve with nonsurgical treatments.
Causes of Severe Shoulder Pain
- End stage osteoarthritis (wear and tear arthritis) that destroys the cartilage that cushions the bones, causing the bones to rub together, resulting in significant pain and disability.
- Rheumatoid arthritis that affects the joint and causes cartilage loss, pain and stiffness.
- Post traumatic arthritis following a severe shoulder injury.
- Rotator cuff tears that lead to arthritis which destroys the joint cartilage.
- Severe fractures that shatter the upper arm bone. Older people with osteoporosis are most at risk for severe shoulder fractures.
- Failure of a previous shoulder replacement.
Shoulder Replacement Options
The choice of procedure is determined by the amount of healthy soft tissue, tendons and rotator cuff.
Total Shoulder Replacement (also called traditional or anatomic shoulder replacement) replaces the damaged ends of the upper arm bone and the shoulder bone with metal and plastic parts. The parts may be cemented or press-fit into the bone. Good quality bone is necessary for the press-fit implants.
- Patients with bone on bone osteoarthritis and intact rotator cuff tendons are the best candidates for this procedure.
- The goal is pain relief and secondarily to restore motion, strength and function.
This is an open surgical procedure with a small incision along the front of the shoulder and the upper arm. The patient can receive regional anesthesia and/or general, and often these are used together.
- The front rotator cuff tendon is released or moved with a small piece of bone toor access. The arthritic parts of the shoulder ball and socket are removed. A new implant will be placed for the socket and ball. The rotator cuff tendon and tendon with the bone are repaired back together and the incision is cleaned, and bandaged.
- At six months most patients are pain free and have a return of near full motion and strength. At one year, eighty-five percent or more of patients will be pain free and without strength or motion limitations. The remaining 15% of patients will have improvements in pain and motion compared to their arthritic state.
A Reverse Shoulder Replacement
This approach is for patients who have:
- A completely torn rotator cuff and severe shoulder weakness
- Severe arthritis and rotator cuff tearing
- A previous replacement that failed
- A severe fracture of the proximal humerus
These patients cannot have a conventional shoulder replacement, often have severe disability, and are unable to raise the arm away from the side beyond ninety degrees.
A reverse technique offers stability and does not rely on the tendons. The deltoid muscle is used to move the shoulder instead of the rotator cuff. Thus, this approach is perfect when the damaged shoulder needs new surfaces, but there is not enough healthy tissue to stabilize and move the shoulder.
Partial Shoulder Replacement (Shoulder Hemi-Arthroplasty)
There are 2 types:
- Shoulder Resurfacing. This only replaces the surface of the head of the arm bone for improved mobility. The original socket is maintained. This is often used for young active patients and avoids complete removal and replacement of the humerus head.
- Partial replacement of the head of the arm bone that has been severely fractured or damaged from arthritis.
Outpatient Minimally Invasive Shoulder Replacement
This is a newer procedure that provides total shoulder replacement as an outpatient procedure. Only short incisions are needed, and there is no moving or cutting of the rotator cuff and muscles. Because there is no damage to the rotator cuff, there are no activity restrictions and recovery is faster, about three months. Other benefits include same day surgery versus several days in the hospital which decreases costs, decreased risk of infection, less blood loss, minimal damage to soft tissues, less pain, fewer complications, reduced recovery time and faster return to recreational activities.
Indications for Surgery
End stage arthritis pain is the primary indication of the need for a total shoulder replacement.
X-rays are used to determine the condition of the joint. A CT scan or MRI may be recommended to evaluate bone quality, and the condition of the soft tissue including the rotator cuff. If nerve damage is suspected, a Nerve Conduction test will evaluate the nerves that control the shoulder muscles.
When Total Shoulder Replacement Is Not Recommended
- When the symptoms are not severe enough and disability is not sufficient to warrant this surgery
- When the patient has loss or paralysis of the rotator cuff and deltoid muscles
- Patients with infection in the shoulder joint
- Patients with nervous system disease that affects the joint
When the shoulder condition involves the ligaments, muscles, tendons or rotator cuff tears or disease, minimally invasive shoulder arthroscopy is recommended.
At South County Orthopedic Specialists (SCOS) in Orange County California, Dr. Ari Youderian is a shoulder and elbow specialist, who routinely performs shoulder replacements and complex shoulder reconstructions. Dr. Youderian trained at the Cleveland Clinic with world experts in shoulder surgery and continues to research and innovate in the field of shoulder replacement. AT SCOS, we strive for compassionate, personalized care and treatment options geared towards your needs.
Shoulder and Elbow Specialists
Ari Youderian, MD
Dr. Youderian is a board-certified, orthopedic surgeon who specializes in care of the shoulder, upper arm and elbow. Read Dr. Youderian’s biography.