Total Shoulder Replacement

What is a total shoulder replacement?

A total shoulder replacement is a procedure in which the doctor removes your shoulder joint and replaces it with an artificial one.

When is it used?

This procedure is done when the joint is painful and not working properly, such as with arthritis, in which the range of motion is restricted and use of the arm is limited. It is done when other treatments have not worked.

Alternatives to this procedure include use of acetaminophen, aspirin, or other drugs for pain and inflammation. Also, you may choose not to have treatment, recognizing the risks of your condition. You should ask your doctor about these choices.

How do I prepare for a total shoulder replacement?

Because you may need blood transfusions during the procedure or during recovery, you may want to donate your own blood before surgery.

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.

Follow any instructions your doctor 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 receive a general anesthetic. This is a drug that will relax your muscles and keep you from feeling pain. The doctor will make a cut over your shoulder and expose the shoulder joint. The doctor will detach the muscles from the shoulder and separate the humerus (arm bone) from the scapula (shoulder blade). The doctor will cut off the ball part of the joint and put an artificial replacement in it. The doctor may replace the socket part of the joint if it is worn.

The doctor will attach the muscles to your shoulder and arm. The doctor 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. You may need blood transfusions. The doctor may put your arm in a sling to keep it still. Walk as soon as you can. Your doctor will discuss when you can begin using your new shoulder, usually in about 3 or 4 weeks.

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

What are the benefits of this procedure?

You may regain use of your shoulder joint and 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 doctor.
• The arteries or nerves may be damaged or cut.
• The nerves in the shoulder area may be injured because of swelling or pressure.
• You may lose a lot of blood and need a blood transfusion. If you have not donated blood previously, the hospital will try to match your blood carefully with donated blood. It is not always possible to avoid reactions with donated blood, and you may acquire a disease from the blood.
• Your arms may not be the same length after the operation.
• The replacement part may become loose or break.
• The upper arm or collarbone may be broken during surgery, which could require a longer hospital stay.
• The new shoulder joint will not move as well as a normal joint. It can be dislocated easily any time after the surgery.
• 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.
• Infection or bleeding may occur.

The probability of any of the above risks occurring is low. You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop a fever.
• You notice excessive drainage from the wound.
• You become short of breath or cough up blood.
• You develop chest pain.
• You find the shoulder becoming very painful or dislocated.
• You have unusual swelling, warmth, or redness in your shoulder.

Call the doctor during office hours if:

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