Total Shoulder Replacement

A total shoulder replacement is a procedure in which the doctor removes your shoulder joint and replaces it with an artificial one.

When is it used?
This procedure is done when the joint is painful, such as with arthritis, in which the range of motion is restricted and use of the arm is limited. It is done when other treatments have not worked.

Alternatives to this procedure include drug therapy, physical therapy, arthroscopic surgery, and limitation of activities. Also, you may choose not to have treatment, recognizing the risks of your condition. You should ask your doctor about these choices.

How do I prepare for a total shoulder replacement?
You can talk to someone who has had a shoulder replacement to get an idea of what the procedure and recovery period are like.

Talk to your doctor about what to expect both in the hospital and after discharge from the hospital.

Because you may need blood transfusions during the procedure or during recovery, you may want to donate your own blood before surgery.

Plan for your care and recovery after the operation. Allow for time to rest and find people to help you with your care and day-to-day duties for at least the first week at home.

Follow any instructions your doctor may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?
You will receive a general, a regional anesthetic, or a combination of the two. A general anesthetic will place you in a deep sleep and prevent you from feeling pain during the operation. A regional anesthetic involves injecting numbing medicine around the nerves that provide sensation for the shoulder. The doctor will make an incision over your shoulder and expose the shoulder joint. The doctor will cut off the ball part of the joint (the proximal humerus) and replace it with a metal ball attached to a stem placed down the arm bone. The new ball is cemented in place. A plastic liner is often cemented to the socket (glenoid) to complete the total joint replacement.

The doctor may place some drains in the wound to drain any blood that collects there. He or she will sew or staple the incision closed.

What happens after the procedure?
You may be in the hospital for at one to four days, depending on how quickly your shoulder heals. You may need blood transfusions. The doctor will probably put your arm in a sling to keep it still. Walk as soon as you can. Your doctor will discuss when you can begin using your new shoulder, but gentle, passive motion exercises are usually started immediately.

Ask your doctor what steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?
The primary reason for having a total shoulder replacement is pain relief. You may regain use of your shoulder joint and no longer have the pain and discomfort of the diseased joint.

What are the risks associated with this procedure?
There are some risks when you have general anesthesia. In the elderly, mild to severe confusion can occur which may last from hours to weeks after general anesthesia. Discuss these risks with your doctor.

• The arteries or nerves may be damaged or cut.
• You may lose a lot of blood and need a blood transfusion. If you have not donated blood previously, the hospital will try to match your blood carefully with donated blood. It is not always possible to avoid reactions with donated blood, and very rarely you may acquire a disease from the blood.
• The replacement part may become loose or break.
• The new shoulder joint will not move as well as a normal joint. It can be dislocated more easily after surgery.
• At the time of surgery, the new ball joint is forced into the arm bone where the marrow normally exists. As a result, pieces of fat in the bone marrow come loose, enter the bloodstream, and lodge in your lungs. Fortunately, this rarely causes problems.
• Infection or bleeding may occur.

The probability of any of the above risks occurring is low. You should ask your doctor how these risks apply to you.

When should I call the doctor?
Call the doctor immediately if:

• You develop a fever.
• You notice drainage from the wound.
• You become short of breath or cough up blood.
• You develop chest pain.
• The shoulder becomes very painful or dislocated.
• You have unusual swelling, warmth, or redness in your shoulder.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.