Shoulder replacement

Shoulder replacement surgery is a procedure during which a surgeon replaces the shoulder joint with artificial parts. If non-surgical interventions like medication or physical therapy are not relieving pain, a shoulder replacement may help you return to your everyday activities pain-free. 

Dignity Health orthopedic surgeons are skilled when it comes to diagnosing, repairing, and treating shoulder pain. Our orthopedic specialists perform shoulder replacement surgeries that get you back to the activities you love. 

Why it’s necessary

Shoulder replacement surgery becomes necessary when you have not been able to relieve your shoulder pain with typical non-surgical treatments such as physical therapy, injections, or medications. If you have chronic shoulder pain due to injury or arthritis, talk to your doctor to see if a shoulder replacement is right for you. 

Before recommending surgery, your doctor will begin by taking a complete medical history and performing a physical exam. To prepare for your appointment, it can be helpful to write down specifics about the symptoms you are experiencing, such as how long pain has been present, if anything makes it better/worse, and your treatment history. During the physical exam, your doctor will check your shoulder’s range of motion, stability, and strength.

Imaging tests such as x-rays and MRI scans help your doctor see the extent of your shoulder damage. They will be able to see the space between your bones, how much space is lost, irregular shaping of the bone, or any loose pieces of bone or cartilage in the joint space. MRI scans are used to view soft tissue. The state of your tissue may help determine what type of shoulder transplant you’ll need.

The results of your test will help your doctor recommend the best course of treatment for your case, including what joint replacement method is best. 

Common conditions treated with shoulder replacement surgery

Shoulder replacement surgery treats the following conditions: 

• Arthritis 
• Broken shoulder bone 
• Torn rotator cuff 
• Other conditions causing joint deterioration

Shoulder replacement surgery is seen as the final step for patients suffering from chronic shoulder pain. It is generally used only when non-surgical interventions such as physical therapy, injections, or medication have not worked to relieve your pain.

Types

There are several types of shoulder replacement surgeries. Talk with your doctor to decide which treatment will work best for you: 

• Anatomical shoulder replacement. This is the most common type of shoulder replacement. It involves attaching a plastic lining to the socket and a metal stem on the top of the arm bone. Anatomical shoulder replacements are usually used when a patient has osteoarthritis or rheumatoid arthritis in their shoulder. 
• Stemmed hemiarthroplasty. Your surgeon may opt only to replace the ball of the head of the humerus if the natural humeral head is severely fractured, but the socket is normal. Patients generally report more pain relief from a total shoulder arthroplasty than hemiarthroplasty alone. 
• Resurfacing hemiarthroplasty. This is used just to replace the joint surface of the humeral head. Your surgeon will use a cap-like prosthesis without a stem. This offers an alternative to the standard shoulder replacement. Resurfacing hemiarthroplasty is a good option for young or very active patients as it avoids the risks of wear and loosening. It is additionally easier to convert to a total shoulder placement later on if needed. 
• Reverse shoulder replacement. Also called a reverse arthroplasty, this treatment involves having an artificial ball attached to the shoulder blade and an artificial socket attached to the arm bone. It reverses the typical ball and socket joint. The deltoid muscle can continue to move the arm. This is most often used when the tendons of the shoulder are severely damaged. 

Risks

As with any surgery, there are risks with shoulder replacement surgery. These may include, but are not limited to: 

• Infection at the surgical site or deep in your joint around the prosthesis (if severe enough, major infections require the prosthesis to be removed until the infection is cleared) 
• Nerve injury 
• Prosthesis problems

These complications are all quite rare. Your doctor will prescribe you antibiotics to limit the chance of infection.

If a nerve injury were to occur during shoulder surgery, it would usually improve over time. Nerve injuries may even heal fully on their own.

Prosthesis problems include a loosening or dislocation of the new joint. As time goes by, it is normal for your joint to loosen up a bit. Excessive wear or loosening would require additional surgery to repair. 

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.