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Understanding the Shoulder Replacement Surgery, Different Types and it's Procedures

Shoulder replacement surgery is becoming more common as the population ages and the prevalence of shoulder-related conditions increases. According to data from the American Academy of Orthopaedic Surgeons (AAOS), over 70,000 shoulder replacements are performed each year in the United States alone. This number is expected to increase in the coming years as the population ages and demand for joint replacement surgeries grows.


Shoulder replacement surgery is typically more common in older individuals, particularly those over the age of 60. This is because shoulder-related conditions such as osteoarthritis and rotator cuff tears become more common with age. However, shoulder replacement surgery may also be recommended for younger individuals with severe shoulder damage or injury.


The frequency of shoulder replacement surgeries may also vary by region, as factors such as access to healthcare, demographics, and lifestyle choices can affect the prevalence of shoulder-related conditions. In general, shoulder replacement surgery is more common in developed countries with higher standards of healthcare, but rates may also be influenced by cultural and socioeconomic factors.


Overall, while shoulder replacement surgery is still considered a major surgery with risks and potential complications, it has become a relatively common and effective treatment option for people with severe shoulder pain and disability.


What are the common conditions that need shoulder replacement surgery?


Shoulder replacement surgery is typically recommended for patients with severe pain and limited function in the shoulder joint due to damage or disease. Some common conditions that may require shoulder replacement surgery include:


Osteoarthritis - This is the most common reason for shoulder replacement surgery. Osteoarthritis is a degenerative joint disease that causes the cartilage in the shoulder joint to wear down over time, resulting in pain, stiffness, and limited range of motion.


Rheumatoid arthritis - Rheumatoid arthritis is an autoimmune disease that can cause inflammation and damage to the joints, including the shoulder joint.


Rotator cuff tear arthropathy - This condition occurs when a patient has a long-standing rotator cuff tear that leads to arthritis in the shoulder joint.


Avascular necrosis - This is a condition that occurs when the blood supply to the shoulder joint is disrupted, leading to bone death and joint damage.


Post-traumatic arthritis - This condition can occur following a severe injury or trauma to the shoulder joint, such as a fracture or dislocation.


Failed previous shoulder surgery - In some cases, patients may require shoulder replacement surgery after a previous surgery has failed to provide adequate relief from pain or restore function to the joint.


It's important for patients to consult with a qualified orthopedic surgeon to determine if shoulder replacement surgery is appropriate for their individual situation. The surgeon will evaluate the patient's medical history, perform a physical exam, and order any necessary imaging studies to make an accurate diagnosis and develop a personalized treatment plan.


What is shoulder replacement surgery?


Shoulder replacement is a surgical procedure that involves replacing a damaged or worn-out shoulder joint with an artificial joint made of metal, plastic, or ceramic materials.During the surgery, the surgeon will make an incision in the shoulder and remove the damaged parts of the joint, including the ball-shaped end of the upper arm bone (humerus) and the socket (glenoid) in the shoulder blade (scapula). They will then replace these parts with the artificial joint components, which are fixed in place with bone cement or by using a special material that encourages bone growth around the implant.


What are the different types of shoulder replacement surgery?


The type of shoulder replacement used will depend on the individual's specific condition and needs. The most common types of shoulder replacement are:


Total Shoulder Replacement (TSR) - In this procedure, the entire shoulder joint is replaced with a prosthetic implant. The implant includes a metal ball and stem that is placed into the humerus (upper arm bone), and a plastic socket that is placed into the shoulder blade.

Patients who undergo TSR may experience a longer recovery time than those who undergo other types of shoulder replacement surgery. It may take several months before the patient can return to their normal activities, and physical therapy will be an important part of the recovery process to restore range of motion and strength in the shoulder.


Reverse Shoulder Replacement (RSR) - This procedure is typically recommended for patients with severe rotator cuff damage or arthritis combined with rotator cuff arthropathy. In this surgery, the positions of the ball and socket are reversed - a metal ball is attached to the shoulder blade and a plastic socket is attached to the upper arm bone. Patients who undergo RSR may experience a quicker recovery time than those who undergo TSR, due to the fact that the surgery is often performed on patients with severe rotator cuff damage who have limited mobility. However, patients may still need to undergo physical therapy to restore range of motion and strength in the shoulder.


Partial Shoulder Replacement - In this procedure, only the damaged or diseased parts of the shoulder joint are replaced with a prosthetic implant. This is typically recommended for patients with osteoarthritis or rheumatoid arthritis that only affects one part of the shoulder joint. Patients who undergo partial shoulder replacement may experience a shorter recovery time than those who undergo TSR, as the surgery is less invasive and only the damaged or diseased parts of the shoulder joint are replaced. However, patients will still need to undergo physical therapy to regain strength and mobility in the shoulder.


Stemless Shoulder Replacement - This is a newer type of shoulder replacement surgery that involves using a shorter, stemless implant that is designed to fit more naturally into the bone. This procedure may be recommended for patients with good bone quality who require shoulder replacement surgery. Recovery after stemless shoulder replacement may be similar to that of partial shoulder replacement, as this procedure is also less invasive and only replaces the damaged parts of the shoulder joint. However, the recovery may still vary depending on the patient's individual situation and the extent of the damage to the shoulder joint.


It's important to note that the type of shoulder replacement surgery recommended for a patient will depend on several factors, including the specific condition being treated, the patient's age, activity level, and overall health. The surgeon will evaluate the patient's individual situation and recommend the best treatment plan.


What is the recovery time after shoulder replacement surgery?


The recovery time after shoulder replacement surgery can vary depending on a variety of factors such as age, overall health, and the specific type of surgery performed. However, based on recent research studies, the typical recovery time for shoulder replacement surgery is around 6 to 12 weeks.


During the first few weeks after surgery, patients will need to wear a sling to support the shoulder and limit movement. Physical therapy exercises for shoulders will be gradually introduced to improve range of motion, strength, and flexibility in the shoulder. Patients may also need to take pain medications and/or antibiotics as prescribed by their doctor.


After several weeks, patients may be able to resume light activities such as driving and light household chores. However, it is important to avoid heavy lifting and strenuous activities until cleared by a doctor. Full recovery may take several months, and it may be up to a year before the shoulder is fully healed and functioning at its best.


It is worth noting that individual recovery times can vary based on a variety of factors, and patients should follow their doctor's specific instructions regarding post-surgical care and rehabilitation. Additionally, it is important to attend all scheduled follow-up appointments to monitor progress and address any concerns.


How to prepare for shoulder replacement surgery?


Preparing for shoulder replacement surgery is an important part of ensuring a successful outcome. Here are some steps that recent research suggests can help patients prepare for shoulder replacement surgery:


Medical evaluation: Before surgery, patients will typically undergo a medical evaluation to assess their overall health and identify any potential risks or complications. This may involve blood tests, imaging tests, and other diagnostic procedures.


Pre-surgical education: Patients may be offered pre-surgical education to help them understand what to expect during and after surgery. This may include information on the surgical procedure, post-operative care, and rehabilitation.


Medication management: Patients should inform their doctor of all medications they are taking, including prescription medications, over-the-counter medications, and supplements. Some medications may need to be stopped or adjusted before surgery to reduce the risk of bleeding or other complications.


Lifestyle changes: Patients may be advised to make certain lifestyle changes before surgery, such as quitting smoking or losing weight, to reduce the risk of complications.


Home modifications: Patients may need to make modifications to their home to prepare for their recovery period, such as installing grab bars in the bathroom, rearranging furniture to reduce trip hazards, or purchasing a comfortable recliner.


Plan for post-operative care: Patients may need assistance with daily activities such as bathing, dressing, and cooking during the recovery period. It is important to arrange for a caregiver or family member to provide support as needed.


Prepare for rehabilitation: Rehabilitation is a crucial part of the recovery process after shoulder replacement surgery. Patients should plan to attend all scheduled physical therapist appointments and follow their therapist's instructions for at-home exercises and activities.

Overall, by taking steps to prepare for shoulder replacement surgery, patients can help ensure a smoother recovery and a successful outcome. It is important to discuss any concerns or questions with your doctor or healthcare team before and after surgery.


Physical therapy rehabilitation after shoulder replacement surgery


The rehabilitation protocol after shoulder replacement surgery is based on evidence-based practices and is typically tailored to the individual patient's needs and goals. However, there are some general principles that are followed in most rehabilitation protocols. These may include:


Immobilization phase: Immediately after surgery, the shoulder may be immobilized with a sling or brace to protect the joint and allow it to heal. During this phase, patients will be instructed to avoid any movements that could stress the joint or interfere with the healing process. This phase typically lasts for 2-6 weeks, depending on the type of surgery performed and the surgeon's recommendations.


Passive range of motion: Once the immobilization period is over, patients may begin passive range of motion exercises, which involve gently moving the arm and shoulder without using the muscles to initiate the movement. This helps to prevent stiffness and maintain joint mobility. This phase typically lasts for 2-4 weeks.


Active range of motion: As the shoulder begins to heal, patients will progress to active range of motion exercises, which involve using the muscles to initiate the movement. This helps to improve strength and flexibility in the shoulder. This phase typically lasts for 4-8 weeks.


Strengthening exercises: This phase typically lasts for 8-12 weeks. Patients may begin strengthening exercises to improve the strength of the shoulder muscles. These exercises may involve the use of resistance bands or weights, and may be gradually increased in intensity over time.


Functional exercises: As the shoulder continues to heal, patients may begin functional exercises that mimic everyday activities, such as reaching overhead or carrying objects. This helps to improve the patient's ability to perform daily tasks. This phase typically lasts for 12-16 weeks.


Return to normal activities: As the patient progresses through the rehabilitation protocol, they may be cleared to gradually return to normal activities, such as sports or heavy lifting. The timing of this will depend on the patient's individual progress and the type of surgery performed.This phase typically occurs after 16 weeks.


It is important to note that the specific rehabilitation protocol will vary depending on the patient's individual needs and goals, as well as the surgeon's recommendations. Patients should work closely with their physical therapist and surgeon to develop a rehabilitation plan that is tailored to their specific needs and goals.


What are the precautions that need to be taken after shoulder replacement surgery?


Precautions after shoulder replacement surgery may vary depending on the phase of rehabilitation. Here are some examples of precautions related to each phase:


Phase 1: Acute Phase (0-6 weeks)


Avoid using the affected arm for heavy lifting or reaching overhead to prevent damage to the surgical site and promote healing.

Use a sling or brace as directed to immobilize the shoulder and protect the surgical site.

Avoid sudden movements or jerking motions with the affected arm to prevent pain or damage to the surgical site.


Phase 2: Intermediate Phase (6-12 weeks)


Continue to avoid heavy lifting or reaching overhead until cleared by the surgeon or physical therapist.

Gradually increase the intensity and duration of exercises to avoid overuse or strain on the shoulder.

Follow the prescribed exercise program and avoid performing exercises that cause pain or discomfort.


Phase 3: Advanced Phase (12-24 weeks)


Continue to avoid heavy lifting or activities that may strain the shoulder until cleared by the surgeon or physical therapist.

Gradually return to normal daily activities and hobbies, but be mindful of any pain or discomfort in the shoulder.

Continue to perform prescribed exercises and follow the recommended exercise program.


What are the complications related to shoulder replacement surgery?


As with any surgical procedure, shoulder replacement surgery carries certain risks and potential complications. While the overall complication rate is relatively low, some of the most common complications associated with shoulder replacement surgery include:


Infection - Infection is a rare but serious complication that can occur following any surgical procedure, including shoulder replacement surgery. Patients may be given antibiotics before and after surgery to help reduce the risk of infection.


Dislocation - Dislocation occurs when the new shoulder joint becomes dislodged from its socket. This can occur if the patient moves the arm too forcefully or makes sudden movements before the joint has had a chance to fully heal.


Implant loosening - Over time, the artificial joint components may become loose or unstable, which can cause pain and limited range of motion in the shoulder.


Nerve injury - During surgery, there is a risk of nerve damage or injury to the surrounding tissues and structures. This can cause weakness or numbness in the arm or hand.


Blood clots - Blood clots can form in the veins of the leg or arm after surgery, which can be potentially life-threatening if they travel to the lungs or heart.


Pain or stiffness - Some patients may experience persistent pain or stiffness in the shoulder following surgery, which may require additional treatment or physical therapy to resolve.

It's important for patients to discuss the potential risks and complications of shoulder replacement surgery with their surgeon, and to carefully follow all post-operative instructions to help minimize the risk of complications and ensure a safe and successful recovery.


What do research studies suggest about shoulder replacement surgery?


Evidence-based practice suggests that successful shoulder replacement surgery requires a combination of factors, including proper patient selection, surgical technique, post-operative care, and rehabilitation.


Patient selection: Appropriate patient selection is critical to the success of shoulder replacement surgery. Patients with severe shoulder pain, stiffness, and disability, who have not responded to non-surgical treatments, may be good candidates for the procedure. Patients with certain medical conditions, such as uncontrolled diabetes or heart disease, may not be suitable candidates for surgery.


Surgical technique: Advances in surgical techniques and implant design have improved the success rates of shoulder replacement surgery. The use of computer-assisted surgery and other technologies can help improve accuracy and precision during the procedure, leading to better outcomes.


Post-operative care: Proper post-operative care is critical to the success of shoulder replacement surgery. This includes monitoring for complications, such as infection or blood clots, and providing appropriate pain management and antibiotic therapy. Patients may also need to wear a sling or immobilizer to support the shoulder during the initial recovery period.


Rehabilitation: Rehabilitation is a key part of the recovery process after shoulder replacement surgery. Physical therapy can help improve range of motion, strength, and flexibility in the shoulder, while reducing pain and stiffness. Patients should follow their therapist's instructions for at-home exercises and activities to maximize their recovery.


In summary, evidence-based practice suggests that successful shoulder replacement surgery requires a comprehensive approach that addresses patient selection, surgical technique, post-operative care, and rehabilitation. By following best practices in all of these areas, patients can improve their chances of a successful outcome and a quicker recovery.

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