What is shoulder replacement surgery?

Joint replacement involves surgery to replace the ends of bones in a damaged joint. This surgery creates new joint surfaces.

In shoulder replacement surgery, doctors replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement. Or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement.

The top end of your upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone, that has a rounded head. If the cup-shaped surface of your shoulder bone that cradles your upper arm bone is also damaged, doctors smooth it. Then they cap it with a plastic or metal and plastic piece.

In some cases, surgeons do a reverse total shoulder replacement. It's for people who have painful arthritis in their shoulder and also have damage to the muscles around the shoulder. In this procedure, the surgeon removes the damaged bone and smooths the ends. Then the surgeon attaches the rounded joint piece to the shoulder bone. The cup-shaped piece is used to replace the top of the upper arm bone.

Doctors often use general anesthesia for joint replacement surgeries. This means you'll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can't feel the area of the surgery and you are sleepy, but you are awake. The choice of anesthesia depends on your doctor, on your overall health, and, to some degree, on what you prefer.

Your doctor will let you know if you will stay in the hospital or if you can go home the day of surgery. Some people stay in the hospital 1 or 2 days.

If you need any major dental work, your doctor may recommend that you have it done before the surgery. Infections can spread from other parts of the body, such as the mouth, to the artificial joint and cause a serious problem.

Activity

• Rest when you feel tired. You may take a nap, but don't stay in bed all day.
• Work with your physical therapist to learn the best way to exercise.
• You will have a sling to wear at night. And it's a good idea to also put a small stack of folded sheets or towels under your upper arm while you are in bed to keep your arm from dropping too far back.
• Your arm should stay next to your body or in front of it for several weeks, both while you are up and during sleep.
• You can move your fingers, wrist, and elbow. But don't lift anything with the affected arm for 6 weeks.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.
• Your doctor may advise you to give up activities that put stress on that shoulder. This includes sports such as weight lifting or tennis, unless your tennis arm was not the one affected.

Diet

• By the time you leave the hospital, you will probably be eating your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Your doctor may recommend that you take iron and vitamin supplements.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Don't stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Incision care

• If your doctor told you how to care for your cut (incision), follow your doctor's instructions. You will have a dressing over the cut. A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
• If you did not get instructions, follow this general advice:
  • If you have strips of tape on the cut the doctor made, leave the tape on for a week or until it falls off.
  • If you have stitches or staples, your doctor will tell you when to come back to have them removed.
  • If you have skin glue on the cut, leave it on until it falls off. Skin glue is also called skin adhesive or liquid stitches.
  • Change the bandage every day.
  • Wash the area daily with warm water, and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing.
  • You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing.
  • You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks, or until your doctor tells you it is okay.

Exercise

• Shoulder rehabilitation is a series of exercises you do after your surgery. This helps you get back your shoulder's range of motion and strength. You will work with your doctor and physical therapist to plan this exercise program. To get the best results, you need to do the exercises correctly and as often and as long as your doctor tells you.

Ice

• For pain, put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. If your doctor recommended cold therapy using a portable machine, follow the instructions that came with the machine.

Most people have much less pain after shoulder replacement surgery and are able to do many of their daily activities more easily.

• The shoulder will not move as far as it did before you started having shoulder problems. But the surgery will allow you to do more of your normal activities without pain.
• After surgery, you may be allowed to resume activities such as golfing, riding a bike, swimming, walking for exercise, dancing, or cross-country skiing (if you did these activities before).
• Your doctor may discourage you from doing things that put a lot of stress on the joint.

The younger you are when you have the surgery, and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.

Your artificial joint should last longer if you do not do hard physical work or play sports that stress the joint. Shoulder replacements usually last for about 10 to 20 years.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure to have extra help at home. This is most important if you live alone or care for another person.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of shoulder replacement surgery include:

Blood clots.

People can develop a blood clot in a leg vein after shoulder joint replacement surgery but usually only if they are inactive. Blood clots can be dangerous if they block blood flow from the leg back to the heart or move to the lungs.

Infection in the surgical wound or in the joint.

Infection is rare in people who are otherwise healthy. People who have other health problems, such as diabetes, rheumatoid arthritis, or chronic liver disease, and those who take corticosteroids are at higher risk of infection after any surgery.

Nerve injury.

In rare cases, a nerve may be injured around the site of the surgery. It is more common (but still unusual) if the surgeon also fixes deformities in the joint. These injuries usually get better over time and in some cases may go away completely.

Problems with wound healing.

These problems are more common in people who take corticosteroids or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes.

Lack of good range of motion.

Some people can't move their shoulder far enough to allow them to do their regular daily activities, even after several weeks of recovery. How far you can move your shoulder after surgery depends a lot on how far you could move it before surgery. If this happens, the doctor may give you a medicine to relax your muscles and will gently force the shoulder to move farther.

Dislocation of the upper arm bone (humerus).

This usually only happens if the soft tissues around the shoulder are stretched too soon after surgery. To help prevent dislocation, do not allow your elbow to move past your body toward your back.

Fracture of the upper arm bone.

This is an unusual complication, but it may happen either during or after surgery.

Instability in the joint.

This can be the result of either the soft tissues being stretched too soon after surgery, or the new joint pieces loosening.

The usual risks of general anesthesia.

Risks of any surgery are higher in people who have had a recent heart attack and those who have long-term (chronic) lung, liver, kidney, or heart disease.

You might get intravenous (I.V.) antibiotics for about a day after surgery. You will also receive medicines to control pain, and you might get medicines to prevent blood clots. It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you don't feel well.

When you wake up from surgery, you will have a bandage on your shoulder. And you'll probably have a drain to collect fluid and keep it from building up around your joint. You may also have a compression sleeve on your arm or legs. This sleeve squeezes your arm or legs to help prevent blood clots. You may keep taking medicines to prevent blood clots for several weeks after surgery.

After you go home, watch the surgery site and your general health. If you notice any redness or drainage from the wound, tell your surgeon. You may also be advised to take your temperature twice each day and to let your surgeon know if you have a fever.

You will have an exercise program to follow when you go home, even if you are still having physical therapy. Do the exercises as your physical therapist taught you. Staying on your exercise program will help speed your recovery.

Rehab typically continues after you leave the hospital until you are able to function more independently and you have recovered as much strength, endurance, and mobility in your shoulder as you can. Total rehab after surgery will take several months.

As your rehab continues, you will slowly be able to do more over a period of several weeks.

The main goal of rehab is to allow you to move your shoulder as far as possible so it's easier for you to do daily activities, such as dressing, cooking, and driving. Most people eventually regain about two-thirds of normal shoulder motion after surgery. But other things that affect how much movement you get back after surgery are how much movement you had before surgery and whether the soft tissues around your shoulder were also damaged. It is very important that you take part in physical therapy both while you are in the hospital and after you are released from the hospital to get the most benefit from your surgery.

Living with a shoulder replacement

Your doctor may want to see you from time to time for several months or more to monitor your shoulder replacement. Over time, you will return to many of your presurgery activities.

Stay active to help keep your strength, flexibility, and endurance. Your activities might include light yard work, walking, swimming (after your wound is completely healed and your doctor has approved), dancing, and golf. Your doctor may recommend that you avoid heavy lifting and repetitive activities.

In the future, make sure to let all health professionals know about your artificial shoulder so they will know how to care for you.

Shoulder replacement surgery replaces the worn parts of your shoulder joint. When you leave the hospital, your arm will be in a sling. It will be helpful if there is someone to help you at home for the next few weeks or until you have more energy and can move around better.

You will go home with a bandage and stitches, staples, skin glue, or tape strips. You can remove the bandage when your doctor tells you to. If you have staples, your doctor will remove them in 10 to 21 days. If you have stitches that are not the type that dissolve, your doctor will remove them in 10 to 14 days. Glue or tape strips will fall off on their own over time. You may still have some mild pain, and the area may be swollen for several months after surgery. Your doctor will give you medicine for the pain.

A physical therapist will show you what exercises to do at home.

You will continue the rehabilitation program (rehab) you started in the hospital. The better you do with your rehab exercises, the sooner you will get your strength and movement back. Depending on your job, you may be able to go back to work as early as 2 to 3 weeks after surgery, as long as you avoid certain arm movements, such as lifting. It takes at least 6 months to return to full activity.

In the future, make sure to let all health professionals know about your artificial shoulder so they will know how to care for you.

Doctors recommend joint replacement surgery when shoulder pain and loss of function become severe and when medicines and other treatments no longer relieve pain. Your doctor will use X-rays to look at the bones and cartilage in your shoulder to see whether they are damaged and to make sure that the pain isn't coming from somewhere else.

Shoulder replacement may not be recommended for people who:

• Have poor general health and may not tolerate anesthesia and surgery well.
• Have an active infection or are at risk for infection.
• Have osteoporosis (significant thinning of the bones).
• Have severe weakness of or damage to the muscles around the shoulder.

Some doctors will recommend other types of surgery if possible for younger people and especially for those who do strenuous work. A younger or more active person is more likely than an older or less active person to have an artificial shoulder joint wear out.

Doctors usually do not recommend shoulder replacement surgery for people who have very high expectations for how much they will be able to do with the artificial joint (for example, people who expect to be able to play competitive tennis, paint ceilings, or do other activities that stress the shoulder joint). The artificial shoulder allows a person to do ordinary daily activities with less pain. It does not restore the same level of function that the person had before the damage to the shoulder joint began.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery.
  • You may be given a special soap to use. If you're allergic to the special soap, ask your doctor how to wash your skin. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery usually takes 1 to 3 hours.