Shoulder replacement surgery involves replacing the damaged shoulder joint with a new, artificial joint.
There are two main types of shoulder replacement: anatomic and reverse.
Anatomic shoulder replacement is an operation designed to replace the shoulder joint damaged by arthritis or injury.
If the tendons around the shoulder are badly damaged then it may not be possible to perform an anatomic shoulder replacement and a different type of replacement called a Reverse Total Shoulder Replacement may be required.
There are two main types of anatomic shoulder replacement. A ‘total shoulder replacement’ where the ball and socket are both replaced, and a ‘hemiarthroplasty’ where only the ball is replaced.
Artificial anatomic shoulder joints and are designed to mimic the normal anatomy of your shoulder as much as possible. The replacement of the ball (humeral head) is often made of metal and may include a stem inside the bone. The socket (glenoid) replacement is made from a specially designed plastic.
Reverse shoulder replacement is used if there is damage to the shoulder joint either from an injury or arthritis, and the tendons around the shoulder are badly damaged or torn. This complex operation requires special expertise and experience. It involves reversing the ball and socket so that the socket sits on the arm bone (humerus) and the ball is fixed to the shoulder blade where the socket originally was.
The shoulder has four individual joints. The largest of these joints is a "ball and socket". The ball is formed by the upper arm bone fitting into the socket which is part of the shoulder blade.
Osteoarthritis, a condition that causes joints to become stiff and painful, is one of the most common reasons why patients need shoulder replacement surgery.
An incision is made over the front of your shoulder and the outer layer of muscles at the front of the shoulder are separated, to expose the deep layer of muscles, the rotator cuff, that directly surround the joint. These muscles and the very tight ligaments and capsule that surround the joint are released to expose the joint.
At this stage, a careful assessment of your shoulder is made using a variety of different sized components. Once the correct ones have been selected they are fixed onto the bones. Sometimes cement is used but often the shoulder replacement is designed to grow into your own bones. For an anatomic replacement the muscles and ligaments are then carefully regained.
Shoulder replacement is closed with stitching or staples, which need to be removed after two weeks.
Shoulder and elbow surgery can result in considerable pain and discomfort after the operation. Traditional painkillers are not always effective and have side effects. We usually offer you a local anaesthetic “block” to reduce the pain and discomfort following the procedure and also allow early, more comfortable physiotherapy (if required). This consists of an injection at the side of your neck onto the nerves that supply your shoulder. The injection itself is fairly painless.
The procedure is carried out before the start of your operation. You will have a small plastic tube placed in your arm (drip). Then you may have some sedation to make you feel relaxed. A small numbing injection in the skin is placed prior to the block needle (which is smaller than a blood-taking needle). Your arm will then start to feel very heavy and numb (a similar sensation to when you have been lying on it). This spreads down the outside of the arm (and spares the inside).
Surgery is then carried out under sedation (you are comfortable, relaxed and either awake or sleeping if you prefer) or occasionally under general anaesthesia (you are unconscious and unaware). If you are awake, you are welcome to watch the procedure on a TV screen, and we will explain to you what is happening. If you require any extra pain relief during the procedure, we can easily give you this through your drip. The block will reduce the overall amount of painkilling drugs that you will require during and after the operation.
After your operation
The numbness will usually last for between 8 and 24 hours (depending on anaesthetic mixture used). We will leave your arm in a sling; please protect your arm whilst it is numb.
You will initially experience some ‘pins and needles’ as the block wears off and then some pain. Please prepare for this by taking the painkillers that we provide. Start these before the block wears off and expect to need them regularly for around 48hrs.
Occasionally we may recommend that at the time of the block we also place a small tube (catheter) that is fixed in place and through which we can give you further local anaesthetic to prolong your numbness for a few days. We would recommend this in situations where your pain after the operation is likely to be severe.
Complications of Anaesthesia
Anaesthesia is fairly safe for most people. If your health is not good the risks may be increased. Commoner complications include nausea and sore throat.
Local anaesthetic nerve blocks are generally considered to be safe. There is an approximately 5% (1 in 20) chance that they will fail or not work as well as expected. They tend to cause a small pupil and droopy eyelid temporarily and you may notice a hoarse voice or slight breathlessness.
Rare complications include reactions to the local anaesthetic solutions and nerve injury (the risk of temporary nerve symptoms e.g. tingling, numbness or weakness for a limited period is around 1 in 100 blocks and the overall risk of permanent injury approximately 1 in 5,000- 10,000 injections).
Paracetamol and an anti-inflammatory drug (if suitable for you – usually ibuprofen or diclofenac) are often used in combination. Take these regularly for the first few days.
Your anaesthetist will talk to you about strong painkillers, usually codeine, tramadol, oxycodone or morphine. Take these if your pain is poorly controlled (instructions will be on the packet). Some patients experience light-headedness when taking stronger painkillers; so be careful especially at first (rest up after taking them, don’t carry hot drinks or anything sharp) and take them only to counteract severe discomfort. Nausea and constipation can also occur, so drink plenty of water and increase the fibre in your diet; occasionally laxatives may be required (available from chemists).
If you are discharged on the same day as your operation, there should be someone keeping an eye on you during the first 24 hour period. If the painkillers make you excessively drowsy, then your carer needs to rouse you and ensure you not too sensitive to them.
Emergency contact numbers will be available on your discharge information if you or your carer wishes to talk to a trained member of staff.
You are likely to stay in hospital for one or two nights after shoulder replacement surgery and your arm will be in a specially designed shoulder sling with the wound covered by waterproof dressing. Exercises and physiotherapy will start the day after the surgery and you will be taught all you need to know for the first couple of weeks of recovery before you leave the hospital.
Your sling is likely to be used for four weeks though this may vary by patient. You will be using your hand and arm but will have difficulty with many day to day activities. Most people can start driving again at around six to eight weeks and should have regained good use of the shoulder by then.
Exercises will continue for many months to gain the maximum benefit in term of movement and recovery of strength and power.