Shoulder Replacement

Shoulder replacement, also known as shoulder arthroplasty, is a surgical procedure where a damaged or worn-out shoulder joint is replaced with an artificial prosthetic. This procedure is typically recommended for patients who suffer from severe shoulder pain, stiffness, and limited mobility due to conditions like osteoarthritis, rheumatoid arthritis, or rotator cuff injuries that have caused significant joint damage. The goal of shoulder replacement is to relieve pain, improve joint function, and restore the patient's ability to perform daily activities, such as lifting, reaching, and overhead movements. There are two main types: total shoulder replacement and reverse shoulder replacement.

Shoulder replacement is usually considered when other non-surgical treatments, such as physical therapy, medications, or injections, fail to relieve symptoms of pain and limited mobility. The most common causes of shoulder joint degeneration include osteoarthritis, rheumatoid arthritis, and rotator cuff tears. In these conditions, the cartilage that cushions the bones of the shoulder joint wears down, leading to bone-on-bone contact, which causes pain, swelling, and reduced movement. In some cases, traumatic injuries or fractures may also damage the shoulder joint to the point where replacement surgery is necessary.

Shoulder replacement surgery is the primary treatment for severe shoulder joint damage when conservative measures no longer provide relief. The procedure involves removing the damaged portions of the shoulder joint, typically the humeral head (ball of the shoulder) and the glenoid (socket), and replacing them with artificial components made of metal, plastic, or ceramic. In a total shoulder replacement, both the ball and socket are replaced. In a reverse shoulder replacement, the ball and socket positions are switched, and this is typically used when the rotator cuff is severely damaged or non-functional. The primary goal of surgery is to restore function and alleviate pain.

Before shoulder replacement surgery, patients undergo a comprehensive evaluation to assess their overall health and the extent of shoulder damage. This includes imaging tests like X-rays or MRIs to visualize the joint, along with blood tests and physical exams to assess the patient's fitness for surgery. Patients may need to stop certain medications, particularly blood thinners, in preparation for the procedure. Preoperative physical therapy may also be recommended to strengthen the muscles around the shoulder and improve mobility before surgery. The surgeon will explain the procedure, anesthesia options, and expected recovery, helping the patient set realistic expectations for the post-surgery rehabilitation process.

Shoulder replacement surgery is typically performed under general anesthesia. In a total shoulder replacement, the surgeon removes the damaged humeral head (ball) and glenoid (socket) and replaces them with prosthetic components. The humeral component is usually made of metal, while the glenoid component is often made of plastic. In a reverse shoulder replacement, the positions of the ball and socket are reversed to help compensate for a damaged rotator cuff. The surgeon secures the prosthetic components into the bone and checks for proper alignment and stability before closing the incision. The procedure generally lasts 2-3 hours, depending on the complexity.

After shoulder replacement surgery, patients are moved to the recovery room for observation and pain management. The arm will typically be placed in a sling to immobilize the shoulder and promote healing. Pain management is essential in the first few days, and medications are given to keep discomfort under control. The patient is encouraged to perform gentle movements, such as finger and wrist exercises, to prevent stiffness and promote circulation. Rehabilitation usually begins shortly after surgery with physical therapy focusing on regaining shoulder mobility and strength. Most patients are discharged from the hospital within 1-2 days but will need assistance with daily activities for the first few weeks.

Rehabilitation is crucial to the success of shoulder replacement surgery. Physical therapy usually begins within the first few days after surgery, with a focus on gentle range-of-motion exercises to prevent stiffness. As the shoulder heals, strengthening exercises are introduced to rebuild muscle strength and improve function. Full recovery may take 6-12 months, depending on the individual and the complexity of the surgery. Most patients can return to normal activities, including light lifting and overhead movements, within 3-6 months, while more strenuous activities may take longer. Long-term recovery involves maintaining shoulder strength through regular exercises and avoiding activities that place excessive stress on the shoulder joint. Follow-up visits with the surgeon ensure that the prosthetic is functioning correctly and the shoulder is healing properly.