Orthopedic Surgery, Shoulder Surgery

June 6, 2022

What Happens During a Total Shoulder Replacement Surgery?

Shoulder joint model

If you experience severe pain and limited movement in your shoulder joint that hasn’t responded to treatment, your doctor may recommend total shoulder replacement surgery. This is a complex surgery with significant healing time, but the results can dramatically improve your mobility and reduce or eliminate your discomfort.

When is a Total Shoulder Replacement Needed?

If you have advanced osteoarthritis in your shoulder or have suffered a traumatic injury to the joint, a total shoulder replacement may be needed to restore movement and strengthen the joint. Osteoarthritis results from aging, normal wear and tear, and repetitive motions. People with repetitive jobs or who play sports such as tennis are more likely to develop debilitating osteoarthritis in the shoulder joint. A rotator cuff injury may also require total shoulder replacement.

If you’ve exhausted other treatment options—including medication, physical therapy, and injections—you may be a candidate for total shoulder replacement surgery. During the surgery, the damaged joint is removed and replaced with an artificial joint that allows the shoulder to move smoothly, restoring range of motion. A metal ball replaces the head of the upper arm bone, and a plastic socket lines the damaged socket.

What to Expect During a Total Shoulder Replacement Surgery

Shoulder replacement surgery is a complex procedure performed by a team that includes your surgeon, anesthesiologist, nurses, and any additional medical personnel needed to ensure your safety and a successful operation.

An anatomic total shoulder replacement surgery removes the ball and socket, replacing them with implants. The metal and plastic or nylon implants look and function like the original ball and socket of your shoulder joint. In a reverse total shoulder replacement, the damaged ball and socket are removed, but the replacement hardware is reversed and implanted after the shoulder and upper arm bones have been sculpted to accommodate them. The ball is fastened to the shoulder blade, and the upper arm bone receives a socket implant. This procedure is often performed when there is severe rotator cuff damage.

Preparation for Total Shoulder Replacement Surgery

Your doctor will explain the procedure in detail in the weeks before your surgery. On the day of the procedure, you’ll be put to sleep using general anesthesia. You’ll also receive a nerve block that lasts for several hours so you can rest comfortably after surgery.

Once you’re in the operating room, you’ll be positioned on a hospital bed in a sitting position. This gives your surgeon better access to the shoulder joint. Your vitals will be monitored throughout the procedure.

During Total Shoulder Replacement Surgery

During the surgery, your surgeon moves aside the pectoral and deltoid muscles to access an area that doesn’t have many nerves. This minimizes the risk of nerve and muscle damage. The shoulder joint is accessed through an incision about six inches long. The surgeon will cut into one of the rotator cuff muscles to get to the joint and manipulate the shoulder blade and ball and socket.

The surgeon examines the upper arm bone after dislocating it from the socket. He will remove damaged areas and bone spurs around the top of the bone. He then removes the humeral head (the ball) and inserts a tapered metal stem into the top of the humerus to hold the replacement ball in place. This gives it stability and strength.

Next, a surgical tool called a reamer is used to scrape, smooth, and shape the glenoid (the socket). This prepares the area to accommodate a new, artificial socket made of plastic or nylon. It’s held in place with pegs or a keel, which is a straight-edged ridge implanted into the surrounding bone. The prosthetic socket is designed to fit with the artificial ball so that your new shoulder joint can glide smoothly.

Some prosthetics are cemented with bone cement, while others are held in place with just the pegs and keel. Your surgeon will determine whether a cemented or press-fit (cementless) joint is appropriate for your shoulder implants.

Before the replacement ball is permanently attached to the humeral stem, the surgeon may try a few different sizes of temporary balls to determine the best fit for stability and comfort. He’ll try out the various sizes by manipulating the shoulder to test for smooth movement and to ensure the joint won’t dislocate. When he’s satisfied, the temporary ball is removed, and the final prosthetic is attached to the stem in the arm bone.

After testing the joint to confirm it’s functioning properly, any cuts in the surrounding muscles and tissue are repaired, and the incision is closed with either sutures or staples. You will be closely monitored in recovery before being released to a hospital room or, in some cases, home.

After Total Shoulder Replacement Surgery

While many patients return home later the same day, most will remain in the hospital following total shoulder replacement surgery. Factors that impact how long you’ll stay in the hospital include the difficulty of your surgery, your overall health, the pain level you feel, and how quickly you recover.

You will begin physical therapy the day after surgery. You’ll also be prescribed pain medications to use after you return home to minimize post-surgery pain. A dressing on the incision will need to be kept dry until the surgeon removes it at your first post-operative visit. Antibiotics may be prescribed to help prevent infection.

Recovering from Total Shoulder Replacement Surgery

Your arm and shoulder will be immobilized with a sling for the first few weeks after surgery. You won’t be able to drive a car during this time, but you can use your hand and lower arm for small movements at waist level.

At-home exercises or physical therapy will be required to keep your arm functioning properly and prevent tightening of the shoulder joint.

Your recovery depends largely on your health, how well you follow your doctor’s instructions, and your physical therapy success. Keep in mind that there may not be a steady improvement—you might advance quickly for a while, then experience a period where improvement stalls. Most people are fully healed within six months to a year after their total shoulder replacement surgery.

Patient Outlook for Total Shoulder Replacement Surgery

The typical success rate of total shoulder replacement is very high. Shoulder pain is almost always eliminated or drastically reduced following the procedure, and most patients also recover full range of movement. However, this depends on the severity of the pre-operative damage and whether you fully commit to physical therapy. Most people can return to swimming, tennis, and golf after about six months.

Is a Total Shoulder Replacement Right for You?

Shoulder replacement surgery is one of the most successful forms of joint replacement surgery, with a relatively short healing time and a low risk of complications. The surgeons at Arkansas Surgical Hospital have performed the procedure many times, providing world-class care to eliminate shoulder pain.

If you suffer form severe pain or mobility issues in your shoulder, talk to the specialists at Arkansas Surgical Hospital. Our surgeons can thoroughly evaluate your shoulder joint to determine if total shoulder replacement surgery is right for you. Request an appointment online or call (501) 748-8000 to schedule a consultation.

Photo by Otto Norin on Unsplash

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