Shoulder Replacement Surgery
The shoulder joint is the ball and socket joint at the junction of the arm and the thorax. The socket of the shoulder is formed by part of the shoulder blade and the ball of the shoulder joint at the top of the arm. The bone in the upper arm (humerus) has a round end that fits into the curved structure on the outside of the shoulder blade. Ligaments and tendons hold this together; the ligaments connect the bones while the tendons connect muscle to the bone. A layer of tissue called cartilage keeps the bones apart so they do not rub against each other.
The ball and socket has the most movement compared to any other joint in the body and allows your arm to move up and down, back and forward and in a circle. However, if the joint becomes damaged, you might need shoulder replacement surgery to replace it.
What is Shoulder Replacement Surgery?
Shoulder replacement surgery, or shoulder ‘arthroplasty’ is required if damage to your shoulder over time makes pain and discomfort difficult to live with. As with hip replacement surgery and knee replacement surgery, shoulder replacement surgery involves removing the damaged joint surfaces and replacing them with artificial parts (prosthesis), usually made of metal or plastic. The aim of the procedure is to relieve pain and improve mobility in the shoulder.
This procedure is available at One Ashford Hospital in Kent, making us ideally placed to see patients in Ashford, Maidstone, Canterbury, Folkestone, Dover and throughout Kent and the surrounding area. Call 01233 428 336 to learn more.
Who is Suitable for this Procedure?
There are a number of reasons why someone may require shoulder replacement surgery, although the most common reason is due to arthritis, a condition causing stiffness of the joint, restricted movement, resulting in pain in the shoulder. Types of arthritis include:
Osteoarthritis is characterised by progressive wearing away of the protective cartilage surface of the joint, eventually leaving bare bones exposed within the shoulder. Also referred to as wear and tear arthritis or degenerative joint disease, it often occurs in people over the age of 50, although when seen in younger people, it can result from injury or trauma such as a dislocated shoulder or fracture. This type of arthritis is known as post-traumatic arthritis. The key symptom of shoulder osteoarthritis is pain, particularly during and after moving the shoulder. Pain may also be felt whilst sleeping, making it difficult to get comfortable and in turn, affecting your sleep pattern. Another symptom is limited range of motion that is noticeable when trying to move your arm. This may result in a clicking or creaking noise in the shoulder joint.
Rheumatoid arthritis (RA) is an autoimmune condition that commonly involves the shoulders, with some people having long periods with few or no symptoms, and others experiencing pain for months at a time. With RA, your immune system mistakenly attacks your joints, causing pain and inflammation of the tissue (synovium) that surrounds the joints. Over time, inflammation can invade and destroy the cartilage and bone. Anterior swelling of the shoulder is common, but it can be difficult to detect upon examination and is often only identified in a minority of patients.
Avascular necrosis (AVN) can result in shoulder arthritis by destroying the joint tissues in the shoulder. It is caused when blood cannot reach the humerus bone (the long bone of the upper arm), causing cells in the shoulder bone to die. Common causes of AVN are due to joint dislocations and bone fractures, although using high doses of steroids and excessive drinking can be a contributing factor. The condition will eventually worsen over time from an asymptomatic disease to mild pain, ultimately leading to severe pain.
Rotator Cuff Tear Arthropathy
Rotator cuff tear arthropathy is a diagnostic term applied to a condition of the shoulder that consists of a torn rotator cuff tendon, along with arthritis of the glenohumeral (ball and socket) joint. Patients will feel pain and weakness in the shoulder, along with an impairment of function.
A bad break in the shoulder bone can also lead to shoulder replacement surgery if it cannot be repaired with an alternative surgical procedure.
To diagnose the cause of your shoulder pain and determine if you need total shoulder replacement surgery, your doctor will carry out a medical history and physical examination to assess your pain, tenderness and loss of motion, along with looking for other signs in the surrounding tissue. Your doctor may be able to tell if the muscle near the joint has signs of atrophy or weakness from lack of use.
To diagnose arthritis in the shoulder, your doctor will refer you for a number of imaging tests that can evaluate the condition of your shoulder and the surrounding soft tissues, such as the rotator cuff. Tests can include:
Your doctor will try to lessen the pain you are experiencing in your shoulder by recommending conservative (non-surgical) treatments before considering surgery. This may include:
Regular exercise and stretching can help keep the shoulder strong and flexible, decreasing the burden on the shoulder and preventing atrophy of the muscles. A physiotherapist will prescribe a set of exercises for you to carry out at home to help decrease your level of pain and maintain the function of the shoulder.
Over the counter painkillers such as ibuprofen and aspirin can help ease pain and lower inflammation in the shoulder, helping you cope better during the day and get better sleep. Topical pain relief gels and creams which have few side-effects compared to oral medication can also help. If pain is persisting, your doctor may recommend a cortisone (steroid) injection. Cortisone is a powerful anti-inflammatory medication that is particularly effective for flare-ups of pain. Cortisone injections usually work within a few days and the effects can last for several weeks. However, Cortisone injections should be used sparingly, particularly in younger people with healthy joints and tendons, as studies have shown they can weaken tendons and soften cartilage. The recommended number per year are 3-4, although some doctors are happy to prescribe more if the patient does not experience any side-effects. These can include:
- Change in skin pigmentation
- Elevated blood sugar
- Loss of fatty tissue
- Pain at injection site
- Tendon rupture
- Facial flushing
Compression can help to reduce pain and swelling. Wrap the shoulder with a cold compression bandage that you can purchase from a pharmacy. Ensure it is well wrapped but not too tight, as you do not want to restrict blood flow. If the arm or hand begins to feel numb or starts to tingle or turn blue, loosen the bandage.
Cold Compress and Heat Therapy
Cold compresses can help reduce swelling in the shoulder. Apply an ice pack for up to 20 minutes, up to 5 times a day. You can use a bag of frozen peas, ice cubes in a plastic bag or a frozen gel pack. Ensure the cold pack is wrapped in a cold towel as otherwise skin damage can occur if placed directly onto the affected area.
Heat can help to relax tense muscles and soothe a stiff shoulder, along with easing pain and arthritis in the shoulder. Use a heated gel pack, hot water bottle or heating pad to help alleviate discomfort.
Preparing for Surgery
A few weeks before your procedure, you will be asked to attend a pre-assessment appointment to determine if you are healthy enough to undergo surgery. Inform the clinician of conditions you have, along with any medications you are currently taking. You might be asked to stop taking certain medications before your procedure, particular anti-inflammatory drugs and blood thinners in order to reduce your risk of bleeding during surgery.
If you smoke, you will be advised to try to stop before undergoing surgery, as you are more likely to experience complications compared to patients who do not smoke. Taking more exercise and reducing alcohol consumption is also recommended.
How is Shoulder Replacement Surgery Performed?
Before surgery, an anaesthetist will administer a general anaesthetic so you will be asleep throughout the procedure, ensuring you feel no pain. Alternatively, you may be given a local anaesthetic (nerve block) during the procedure that will wear off within 24 hours.
The surgeon will make an incision at the front of the shoulder and separate the deltoid and pectoral muscles in order to access the shoulder, enabling them to view the damaged area of the ball and socket joint. The arthritic section of the humerus (arm bone) and glenoid (socket) are substituted with artificial components to replace the worn cartilage. Cement and/or screws are used to hold the components in place. The muscles are then closed and stitched, followed by the initial skin incision. This area is cleaned and a bandage is applied as a temporary dressing.
A total shoulder replacement usually takes between 2-3 hours.
Following surgery will be taken to the recovery room where you will be monitored for the initial post-operative period. When ready, you will be transferred to the ward where you will stay for approximately 2-5 nights, depending on how well you are recovering from your operation. Your shoulder will swell following surgery, and you will likely feel a degree of pain. Post-operative pain is entirely normal and you will be prescribed pain relief to help minimise it. Cold compresses can also help control swelling.
Your arm will initially be placed in a brace to keep it from moving, after which you will begin physiotherapy to start getting movement into your arm, usually within 24 hours following surgery. Undergoing physiotherapy after your operation is vital to regaining strength and movement in your shoulder, so it is important that you follow the exercises given to you. You will be required to continue with these exercises once you are discharged from hospital and return home. Remember that recovery is a gradual process so it is important not to rush things as this could hinder your progress.
Initial recovery from total shoulder replacement surgery, where you will have regained some movement in your arm takes approximately 8 weeks, although some patients can use the whole arm, including the shoulder for light activity from roughly 6 weeks. For some though, it may be several months before they can return to more strenuous activities.
After 3 months, most patients feel reasonably comfortable and have regained about half of the shoulder’s normal range of motion, although weakness can still be felt at this stage of their recovery. Patients are generally pain free after 6 months and have regained approximately two-thirds of their normal range of motion and strength. At approximately 1 year, 95% of shoulder replacement patients are pain free, with some experiencing more weather related aches and pains or discomfort due to over activity. There should be no limitations on strength, provided the deltoid and rotator cuff muscles are in good working order.
Risks and Complications
Most patients do not experience any complications with total shoulder replacement surgery, although as with all invasive surgery, it does carry some risk. Risks include:
- Infection (affects 1 out of every 100 patients but can be treated with antibiotics)
- Blood clots
- Nerve or blood vessel damage
- A reaction to the anaesthetic
- Loosening or dislocation of the replacement components
- Rotator cuff tear
- Stiffness of the shoulder
Outlook after Shoulder Replacement Surgery
A total shoulder replacement can wear out after time, so it is important to take good care of your shoulder and understand that proper and extensive post-operative rehabilitation is a key factor in achieving the maximum benefit from your procedure. However, if any discomfort does return, it is important to relay this to your doctor in order to assess your shoulder and identify any underlying conditions that may need treating.
The surgery will typically last between 15-20 years.
Private shoulder replacement surgery is available at One Ashford Hospital. We also offer a number of other procedures for shoulder and elbow conditions, including SLAP repair and elbow release surgery. We can book you in to see a specialist Orthopaedic Shoulder Surgeon for an initial consultation, usually within 48 hours.
One Ashford Hospital is well placed to see patients from Ashford, Canterbury, Maidstone, Dover, Folkestone and all surrounding areas. Call us on 01233 428 336 to find out more.
You can use your private medical insurance or pay for your Shoulder Replacement Surgery treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, X-ray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience