Shoulder Replacement Surgery

What is a total shoulder replacement?

Shoulder replacement is a procedure done to remove a painful shoulder joint and replace it with an artificial shoulder joint.

When is it used?

This surgery may be done if your shoulder joint is painful or not working well and other treatments have not helped. You may have problems with the joint because of arthritis or upper arm fractures that make it hard to move and use your arm.

Alternatives to this procedure include

• taking acetaminophen, aspirin, or other medicines for pain and inflammation
• using ice or heat to reduce pain and swelling.

Ask your healthcare provider about these choices for treatment.

How do I prepare for a total shoulder replacement?

Talk to someone who has had a shoulder replacement to get an idea of what the procedure and recovery period are like.

Because you may need blood transfusions during the procedure or during recovery, you may want to donate some of your own blood before the procedure. You should donate blood no more than 4 weeks before the procedure.

Plan for your care and recovery after the operation. Allow for time to rest and find people to help you with your care and day-to-day duties for at least the first week at home.

You may meet with a physical therapist before surgery to learn exercises that will help you after surgery.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any instructions your healthcare provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight on the day of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general anesthetic. This is a drug that relaxes your muscles and puts you to sleep. It will keep you from feeling pain during the operation.

The surgeon will make a cut over your shoulder to get access to the shoulder joint. The surgeon will detach the muscles from the shoulder and separate the humerus (arm bone) from the scapula (shoulder blade). The surgeon will cut off the ball part of the joint and put an artificial replacement in its place. The surgeon may replace the socket part of the joint if it is worn.

The surgeon will reattach the muscles to your shoulder and arm. The surgeon may place some drains in the cut to drain any blood that collects there. He or she will sew or staple the cut closed.

What happens after the procedure?

You may be in the hospital for at least 1 to 4 days, depending on how quickly your shoulder heals. Your healthcare provider may put your arm in a sling to keep it still. Walk as soon as you can.

When you return home:

• Do not lift anything heavier than a cup of coffee for the first 6 weeks after surgery.
• Wear the sling every night for at least the first month.
• Avoid contact sports and heavy lifting for at least 6 months.
• Don’t use your arm to push yourself up in bed or from a chair.
• Follow the exercise program prescribed by your healthcare provider.

Constipation is common after joint replacement surgery. It is caused by narcotic pain killers as well as inactivity. You may be given a stool softener and a laxative after surgery to avoid this. When you are home again, be sure to eat a high-fiber diet and plenty of liquids according to your provider’s recommendations.

Your healthcare provider will discuss when you can begin using your new shoulder. Usually you can start using it again in about 3 or 4 weeks. Ask your provider what activities you should avoid.

Ask your provider what other steps you should take and when you should come back for a checkup.

Will I need to take antibiotics to prevent infection in the artificial shoulder?

Some healthcare providers may recommend taking an antibiotic before and right after you have a dental or medical procedure or surgery. This may be done to help prevent an infection around the shoulder replacement. However, such infections are rare, and it’s not clear from studies that taking antibiotics before a procedure helps prevent an infection.

If you do get some other infection (such as a bad gum infection or sinus, bladder, or skin infection), the infection should be treated right away. Let all of your healthcare providers, including your dentist, know that you have an artificial joint. If you are having infections treated with a procedure (like deep cleaning of bad tooth and gum problems, or sinus surgery for infections), talk to your provider about having preventive antibiotics to protect your shoulder.

What are the benefits of this procedure?

You may regain use of your shoulder joint. You may no longer have the pain and discomfort of the diseased joint.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• You may lose a lot of blood and need a blood transfusion. If you did not donate your own blood, the hospital will try to match your blood with donated blood. It is not always possible to avoid reactions with donated blood. You could also get a disease from donated blood, but the risk for this is low.
• The upper arm or collarbone may be broken during surgery, which could require a longer hospital stay.
• At the time of surgery, the new ball joint is forced into the arm bone where the marrow normally exists. As a result, pieces of fat in the bone marrow may come loose, enter the bloodstream, and lodge in your lungs. Fortunately, this is rare.
• The arteries or nerves may be damaged or cut.
• The nerves in the shoulder area may be injured because of swelling or pressure. This may cause some numbness.
• You may have infection or bleeding.
• The new shoulder joint will not move as well as a normal joint. It can be dislocated easily any time after the surgery.
• Your arms may not be the same length after the operation.
• The replacement part may loosen or break.

The probability of any of the above risks is low. Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever.
• You are in uncontrollable pain.
• You become short of breath or cough up blood.
• You have foul-smelling drainage coming from the surgical wound.
• Your shoulder has unusual swelling, warmth, or redness.
• You have chest pain.
• You find the shoulder becoming very painful or dislocated.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.