Severe shoulder pain caused by bone on bone rubbing is the main reason patients opt to undergo total shoulder replacements. Those who choose to get the surgery often complain about pain, loss of function and weakness in the joint. There is also usually proof of soft tissue damage affecting one or all of the following: muscles, tendons and ligaments. If symptoms affect quality of life, are worsening over time and if arthritis is present on an x-ray, a doctor will often recommend either a total shoulder replacement or a reverse shoulder replacement.
There are two main types of total shoulder replacement surgeries: a total shoulder replacement and a reverse total shoulder replacement. The first one is recommended for those who experience bone on bone rubbing caused by worn down articular cartilage but the rotator cuff remains intact. In a reverse shoulder, the rotator cuff—a group of muscles and tendons that surround the shoulder joint—is affected, often beyond repair. In a total shoulder, the shoulder is replaced with a prosthetic. In a reverse shoulder, swapping the ball and scapular sides of the joint, tricks the shoulder to use the deltoid muscle as its primary muscle changing the biomechanics of the joint. Total shoulder replacements have been performed in the U.S. for more than 30 years, but the reverse procedure has only skyrocketed in popularity in the last decade as technique has evolved.
Total shoulder replacements are different than other joint replacement surgeries because the joints are especially complex, which makes the procedure invasive. After the surgery, patients never get a full range of motion back, but functional improvement is expected as well as a significant reduction in pain or complete elimination of pain.
During the procedure, a surgeon removes the painful, arthritic shoulder joint and replaces it with a prosthetic. Computer-aided surgeries are also available for total shoulder replacements. The technology allows for more precise positioning of the prosthetic joint, which allows for better recovery and a longer-lasting solution to shoulder pain. When a patient undergoes this procedure with computer navigation, they will receive 3D CT scans before surgery. This allows the doctor to create a computer simulation of your exact surgery beforehand and practice placing the joint.
Other advances in technology and continued research and updated protocols have made recovery for the surgery much faster. In many cases, patients can be discharged same day. A sling will likely be required for up to two weeks and patients will be into physical therapy within three weeks. In most cases, complete pain relief can be expected in six weeks.
It is important to remain positive and not to lose patience during shoulder surgery recovery. Because the joint is so complex, it can take several weeks to heal and to return to full strength. The good news is the shoulder is not weight bearing, which does help patients return to normal activities sooner and keeps pressure off of the joint during early weeks of healing.
The main purpose of a total shoulder replacement surgery or reverse total shoulder replacement surgery is to relive pain. Patients who undergo these procedures experience daily pain, loss of motion and loss of strength often due to arthritis in the joint, which can be confirmed by x-ray. The surgery allows the patient to regain much of their original range of motion while reducing pain and making it easier to complete daily tasks by removing the arthritic joint.
While full range of motion is never recovered during these surgeries, range of motion is certainly improved. That paired with reduced or eliminated pain is the biggest benefit of surgery. Additional technology has advanced the surgery, making prosthetic placement more precise and therefore extending the life of the implant. Speed up your recovery process by staying mobile, actively participating in physical therapy, maintaining a good diet, participating in low impact exercises approved by your doctor and being mindful of the joint that has recently been replaced.
There are always risks associated with surgery. In addition to risks linked to general anesthesia, there are risks more commonly linked to these procedures. Blood clots, infection, joint dislocation, misalignment or loosening of the joint, instable joint, bone fracture and injury to the blood vessels or nerves have all occurred.
Overall health affects risks. Patients who suffer from other ailments, including diabetes, heart disease, obesity or depression, may be at greater risk for complications during and after surgery. These ailments, as well as others, can also slow the healing process. It is important to take steps to decrease the likelihood of complication before going under the knife. In some cases, stopping bad habits such as smoking or losing weight prior to surgery can increase the likelihood for a positive outcome.
Total joint replacement surgery and reverse total joint replacement surgery typically resolve pain, result in a functional and improved range of motion and make it easier to perform daily activities.
Total shoulder replacement surgery is often a last step for patients with shoulder pain. Before considering surgery, pain management interventions can be explored such as steroid injections or medication. Physical therapy is a popular choice for those who experience shoulder pain and loss of motion either from an injury, arthritis or normal wear and tear. Some doctors use stem cell injections to improve shoulder injuries, including tears in the rotator cuff. There are other surgical interventions that can be tried before a total replacement, including debridement, cleaning out the joint to ease pain; synovectomy, removing the lining of the joint; or removing part of the bone referred to as the radial head at the elbow.
A 2007 study found the average cost of a total shoulder replacement surgery was $10, 351. In most cases, these procedures run between $7,000 and $21,000. Insurance, in many cases, will cover all or part of the procedure costs. The exact price will also be affected by several factors including where you get the surgery done, who performs it, what equipment is used and recovery options.
“How Much Does Shoulder Replacement Cost? – CostHelper.com.” CostHelper. Accessed April 24, 2018. http://health.costhelper.com/shoulder-replacement.html.
“What Are the Alternatives to Shoulder or Elbow Joint Replacement?” Arthritis Research UK. Accessed April 24, 2018. https://www.arthritisresearchuk.org/arthritis-information/surgery/shoulder-and-elbow-replacement/alternatives.aspx.
Stewart, Jason. “Reverse Shoulder Replacement Risks and Complications.” Arthritis-health. Accessed April 24, 2018. https://www.arthritis-health.com/surgery/shoulder-surgery/reverse-shoulder-replacement-risks-and-complications.