Patient education: Shoulder replacement (The Basics)

What is shoulder replacement? — This is surgery to replace part or all of a person's shoulder joint with artificial, or "prosthetic," parts.

The shoulder joint is made up of the upper arm bone, collarbone, and shoulder blade (figure 1). It is a "ball-and-socket" joint. The top of the humerus is ball shaped and fits into part of the shoulder blade.

When a person has problems with their shoulder joint, the shoulder can be painful and stiff, and have trouble moving normally. Different conditions can cause problems with the shoulder. One of the most common causes is osteoarthritis, a type of arthritis.

Shoulder replacement can reduce shoulder pain and improve the way the shoulder moves.

Shoulder replacement is an "open" surgery. This means that the doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

Are there different types of shoulder replacement surgeries? — Yes. Different types of surgery include (figure 2):

●Total shoulder replacement – The doctor replaces both the ball and socket.

●Partial shoulder replacement – The doctor replaces only the ball or adds a cap to cover the ball.

●Reverse total shoulder replacement – The doctor makes a socket on the arm bone and places a ball on the shoulder blade.

You and your doctor will decide the best option for you.

How do I prepare for shoulder replacement? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●CT scan, MRI, or other imaging tests – Imaging tests create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any infections – If you have an infection anywhere in your body, it needs to be treated completely before your doctor can put in the prosthetic.

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

Before surgery, your doctor might want you to:

●Learn about exercises you can do before and after surgery.

●Stop smoking, if you smoke. It takes longer for bones to heal if you smoke. Smoking also increases the risk of problems after surgery.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during shoulder replacement? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. The doctor might also do a "peripheral nerve block" to numb your shoulder area. This can help control pain after surgery.

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You will get medicines to help prevent infection.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision along the front part of your shoulder. They will remove the damaged parts of your shoulder joint and replace them with artificial, or "prosthetic," parts. These can be made out of plastic, metal, or ceramic.

●They will close your incision and cover it with clean bandages.

●The procedure takes about 2 to 3 hours.

What happens after shoulder replacement? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people spend 1 to 3 nights in the hospital after surgery.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●The staff will help you get out of bed and start moving around when you are ready. You will wear a sling to support your shoulder for the next 4 to 6 weeks.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of shoulder replacement? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Dislocation (when the shoulder joint pops out of place)

●Blood clots

●Infection

●Broken bone

●Nerve or blood vessel damage

●Bleeding

●The prosthesis wearing out, loosening, or breaking

●Stiffness of the joint

●A reaction to the material in the prosthetic part

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

When you go home, you will get instructions about physical therapy and specific exercises you should do. Most people start physical therapy and exercises 2 to 6 weeks after surgery. These will help build your muscle strength and flexibility. Physical therapy is a very important part of the recovery process.

More on this topic

Patient education: Shoulder replacement – Discharge instructions (The Basics)
Patient education: Rotator cuff injury (The Basics)
Patient education: Osteoarthritis (The Basics)
Patient education: Shoulder pain (The Basics)
Patient education: Shoulder arthroscopy (The Basics)

Patient education: Rotator cuff tendinitis and tear (Beyond the Basics)
Patient education: Osteoarthritis treatment (Beyond the Basics)