Total Shoulder Replacement Surgery and Reverse Total Shoulder Replacement
During shoulder replacement surgery, all or part of your problem shoulder is replaced with an artificial joint, called a prosthesis. The prosthesis replaces the rough, worn parts of your shoulder with smooth metal and plastic parts. You have many options for different prostheses. Your surgeon will discuss the best one for your condition.
Understanding the shoulder joint
The shoulder joint is where the ball-shaped part of the upper arm bone (humerus) meets the cup-shaped socket of the shoulder blade (scapula). A group of muscles and tendons hold the joint together. These muscles and tendons are called the rotator cuff. The muscles let you move your arm and shoulder.
Why total shoulder replacement is done
- Arthritis
- Rheumatoid arthritis
- Various traumas
- Severe pain and trouble moving your shoulder
- No success relieving your symptoms with treatments such as rest, medicines, cortisone injections, or physical therapy
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| Total Shoulder Replacement |
Reverse Total Shoulder Replacement |
How reverse total shoulder replacement is done
The surgery is the opposite (reverse) of standard total shoulder replacement surgery
- In the standard surgery, the ball of the humerus is replaced with an artificial ball. The socket of the scapula is replaced with an artificial socket.
- With the reverse surgery, the ball of the humerus is replaced with an artificial socket. The socket of the scapula is replaced with an artificial ball.
Risks of total shoulder replacement
Every surgery has risks. Risks for this surgery include:
- Infection
- Blood loss
- Damage to nerves that may make it hard to move your arm
- Damage to the humerus or scapula
- Artificial joint moving out of position (dislocation)
- Problems with anesthesia
Some risks may be higher if you have had shoulder surgery in the past. Your risks may vary depending on your shoulder problem and your overall health. Talk with your doctor about which risks apply most to you.
What to tell your healthcare provider
Before your surgery, tell your healthcare provider:
- What medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin.
- If you smoke. You may need to stop before your surgery. Smoking can delay healing. Talk with your health care provider if you need help to stop smoking.
- If you’ve had recent changes in your health. This includes an infection or fever.
- If you aresensitive or allergic to anything.This includes medicines, latex, tape, and anesthetic medicines.
- If you are pregnant. Also tell your health care provider if you think you may be pregnant.
Tests before your surgery
Before your surgery, you may need tests such as:
- Shoulder X-rays. These are done to view the bones of your shoulder.
- CT scan. This test uses a series of X-rays and a computer to show your shoulder in more detail.
- MRI. This test uses large magnets, radio waves, and a computer to seethe bones, muscles, and tendons in more detail.
Getting ready for your surgery
Make sure to:
- Ask a family member or friend to take you home from the hospital
- Make plans for some help at home while you recover
- Follow all other instructions from your healthcare provider
- Read the consent form and ask questions if something is not clear
- Not eat or drink after midnight before your surgery
On the day of your surgery
Be sure to follow all of your healthcare provider's instructions on preparing for surgery:
- Follow any directions you are given for taking medicines or for not eating or drinking before surgery.
- At the hospital, your temperature, pulse, breathing, and blood pressure will be checked.
- An IV(intravenous) line will be started to provide fluids and medicines needed during surgery.
- You will be given medicine that blocks pain in the area (regional anesthesia).
Your surgical procedure
When the surgical team is ready, you’ll be taken to the operating room.
- There you’ll be given anesthesia to help you sleep through surgery.
- Your surgeon may replace just the ball (partial replacement) or both the ball and the socket (total replacement).
- An incision about six-inches long is made from your collarbone to your arm.
- Once the new joint is in place, your surgeon closes the incision with surgical staples or sutures (stitches).
- The whole procedure may take a few hours.
After your surgery
After surgery, you'll be sent to the recovery area or PACU (post anesthesia care unit).
- You may be sleepy and confused when you wake up.
- Your healthcare team will watch your vital signs, such as your heart rate and breathing.
- Your arm and shoulder will feel numb if you had regional anesthesia.
- Once the anesthesia has worn off and your condition is stable, you'll be moved to your room.
- In some cases, you can be sent home after surgery.
During your hospital stay, your healthcare team will work with you. They will help to control your pain, get you up and walking, and start you on an exercise program. Exercise will help to gently move and strengthen your new shoulder.
Your exercise program
After your surgery, you’ll start a gentle exercise program for your shoulder. This program may begin as soon as the day of your surgery. Your exercise program is a vital part of your recovery.
- You will need to wear an arm sling for a few weeks and will have motion and activity restrictions for weeks to months as you heal.
- Your healthcare provider instruct you to limit external rotation (rotating your shoulder away from your body).
Outpatient physical therapy
How much strength and movement you regain in your shoulder and arm depends on how well and often you do your exercises.
- You'll haveaspecificrehabilitationorphysicaltherapyplantogetthebesthealingaftersurgery.
- Your surgeon or a physical therapist (a rehabilitation specialist) will start by gently moving your arm for you.
- This helps keep your shoulder from getting stiff.
- Next, you’ll begin to move your arm with the help of your other arm.
- As your shoulder heals, you'll begin to lift and move your arm.
- This will help increase your range of motion and strength in the joint.
Recovering at home
The hospital staff will talk with you about your home recovery.
- Follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care.
- Your arm will be in a sling for several weeks.
- You will continue to have some pain as you heal. But any pain you had from the joint damage should be gone.
- Your healthcare provider may give you pain medicine to take at home.
- Continue to use the ice packs provided a on your shoulder as instructed.
- Do physical therapy as instructed.
- Limit the use of your arm and shoulder as instructed.
- Your doctor will tell you when you can return to normal activities.
Follow-up care
Make sure to keep all of your follow-up appointments with your surgeon and with your physical therapist. Most artificial shoulders last for several years before they need to be replaced. Talk with your surgeon about what he or she expects for you.
After Shoulder Replacement Surgery: Back in the Swing
After shoulder replacement, you can look forward to less pain and stiffness. You may also have more strength and movement in your shoulder and arm and be able to return to many of the activities you enjoy—like golf, swimming, bowling, gardening, or playing with your children or grandchildren.
If you follow your exercise program and protect your shoulder, you’ll probably be back in the swing of things within a few months. Your healthcare team will discuss how to wear your arm sling and for how long. You will likely have follow-up visits with physical therapy to make a faster and more complete recovery.
Returning to work
When you can return to work depends on your surgery and the type of work you do. You may be able to go back to a desk job within a few weeks. Your healthcare provider may tell you to resume some tasks gradually or to avoid certain tasks until your shoulder heals. Your return will take longer if your work is more physical. In some cases, your healthcare provider may advise you to change the kind of work you do to avoid overusing or reinjuring your shoulder.
What to remember
Your new shoulder is not designed for heavy impact. Think of it like the tread on a tire: It will wear out faster with hard use. So, you may want to make some choices about how you use your new shoulder.