Shoulder replacement surgery

Shoulder replacement is joint replacement surgery used to treat conditions such as arthritis of the shoulder, osteonecrosis, rotator cuff arthropathy and severe fractures of the shoulder. These conditions can cause severe shoulder pain, hinder the normal range of motion and affect your daily activities and sleep. Shoulder replacement surgery is often recommended if other nonsurgical treatments or surgeries have failed and the patient continues to experience severe symptoms.

According to the Agency for Healthcare Research and Quality, about 53,000 people in the United States have shoulder replacement surgery each year.

Anatomy of the shoulder

Your shoulder is a large joint composed of three bones: the humerus (upper arm bone), scapula (shoulder blade) and clavicle (collar bone). The shoulder is best described as a “ball and socket” joint, because the head of the upper arm bone (humerus) fits into the shallow socket (glenoid) of the shoulder blade.

The surfaces of the bones that connect in the shoulder blade are covered in smooth soft-tissue material called articular cartilage. This cartilage creates protection for the bones while allowing them to move easily within the socket. The substance that covers the remaining surfaces inside the shoulder joint is referred to as synovial membrane. The synovial membrane is thin, smooth tissue that creates fluid and lubricates the articular cartilage in the joint. The lubrication eliminates any friction in the shoulder due to movement.

The muscles and tendons surrounding the shoulder provide stability and support for its vast range of motion. When any part of this structure is damaged, it can immobilize the shoulder joint and cause the need for shoulder replacement surgery.

Your orthopedic surgeon will recommend one of three types of shoulder replacement surgery, depending on the extent of damage in your shoulder:

• Total shoulder replacement—The surgeon begins the procedure with an incision over the shoulder joint. The damaged end of the humerus bone is removed, then replaced with an artificial stem topped with a round, metal ball. The surgeon uses bone cement to hold the artificial humerus head in place. The surgeon will then smooth the surface of the old socket and cover it with a smooth, plastic shell. The artificial socket replacement is cemented onto the old socket.
• Partial shoulder replacement—During this procedure, only one of the two bones of the shoulder joint is replaced.
• Reverse total shoulder replacement—A more beneficial procedure for patients with large, irreparable cuff tears that have led to cuff tear arthropathy, an advanced type of shoulder arthritis. In reverse total shoulder replacement, the socket and the metal ball are switched, with the metal ball attached to the socket and the plastic cup attached to the upper end of the humerus.

While you're in the hospital, a physical therapist will teach you light exercises to prevent your injured shoulder from getting stiff during the healing process. You will be required to wear a sling during your recovery time in the weeks after the procedure. Many people who undergo shoulder replacement surgery are able to go back to their daily activities without pain or stiffness in their shoulder.