Shoulder Replacement

What is shoulder replacement?

Shoulder replacement surgery describes a procedure where the damaged parts of shoulder joint are removed and replaced with new synthetic materials (prosthesis). Also called shoulder arthroplasty, this procedure is typically used to treat severe arthritis where the prominent feature is pain.

Shoulder replacement surgery may involve just replacing the ball (head of the humerus) or both the ball and socket (the glenoid cavity).

Do I need shoulder replacement?

The decision to have this treatment should be made after assessment and discussion with your orthopaedic surgeon. The decision will always be yours to make and you need to carefully consider all of the information you have received including what the expected benefits are, what the risks are and what the alternatives are.

How does shoulder replacement surgery work?

Shoulder replacement may be performed under general anaesthetic or regional anaesthetic or a combination of both.

There are several different techniques, but the general procedure involves making a cut at the front of your shoulder and removing the either just the ball or the ball and the socket. The new ball is typically made of metal, while the socket is usually a type of plastic.The prosthesis is fitted tightly into the bone and anchored into place with bone cement.

After the incisions are closed and a wound dressing placed, you will be fitted with a polysling and body belt.

Reverse shoulder replacement

What is reverse shoulder replacement?

Reverse shoulder replacement describes a procedure where the damaged parts of shoulder joint are removed and replaced with new synthetic materials (prosthesis).But instead of replacing the like with like, the ball is replaced with a plastic cup and the socket is replaced with a metal ball.

Reverse shoulder replacement is a good option for people with:

  • a massive irrepairable rotator cuff tear
  • rotator cuff tear arthropathy
  • shoulder arthritis in the absence of a functional rotator cuff

How does reverse shoulder replacement surgery work?

Shoulder replacement may be performed under general anaesthetic or regional anaesthetic or a combination of both.

After your shoulder is cleaned and prepared for surgery, your surgeon makes a cut at the front or the top of your shoulder and moves soft tissue aside to expose the shoulder joint. The top of the scapula and the ball of the humerus are cut and the shoulder joint is removed. A new ball is attached to the scapula and a cup on rod is inserted into the shaft of the humerus.The prosthesesare anchored into place with bone cement.

After the incisions are closed and a wound dressing placed, you will be fitted with a polysling and body belt.

What is involved and what to expect after shoulder replacement?

In hospital
Day 0

Immediately after surgery you will start therapy consisting of finger, wrist and elbow movements.

Day 1

The body belt is removed and therapy continues with further exercises (pendular exercises, scapular setting, passive flexion, external rotation). You will also be taught how to keep your armpit clean.

Most people are discharged on day 1 or 2 after surgery.

At home
Day 5 to 3 weeks after surgery

Your rehabilitation therapy program will continue as follows.

  • no resisted internal rotation or forced passive external rotation (reattached subscapularis muscle is vulnerable)
  • begin passive abduction (maintain shoulder in IR)
  • passive external rotation to neutral only
  • active assisted flexion in supine and progress to sitting position as soon as you are able
  • progress to active when possible
  • begin isometric strengthening of all muscle groups (except IR)
  • remove sling as able
  • functional reaching activities below 90 degrees

By the end of week 3, you should have 50% of the range of motion you had before surgery. If you have an office type job, you may be able to return to work.

3–6 weeks

Your therapy will now:

  • encourage active movement into all ranges with some gentle self-stretching at the end of range
  • add isometric IR
  • progress with functional activities
6–12 weeks

Your therapy will:

  • progress strengthening through range
  • regularly stretch the joint to the end of its available range
  • involve soft tissue manipulation if required

By the end of week 6, your passive range of motion should be as least as good as it was before surgery. Most people can resume driving at this stage, as week gentle activities such as breast stroke.

12 weeks +

By 12 weeks, your active range of motion should be as least as good as it was before surgery. You can also start swimming freestyle and lifting objects. Your surgeon will advise you if you’re able to return to manual work at this stage.