Your shoulders support you during everyday tasks and have the largest range of motion of all the joints in your body. They must provide stability for tasks like lifting, pushing and pulling. A shoulder replacement is an option when arthritis or injuries cause ongoing pain that doesn’t go away.

Right time for a shoulder replacement

You should consider a shoulder replacement when degenerative issues like arthritis or injuries cause pain that doesn’t decrease with activity modifications. Age is generally not an issue for surgery if you have good health. However, if you let arthritis go too long, the bone wears away and surgery may not be possible.

If you have pain, your provider will recommend non-operative treatment options like anti-inflammatory medications, activity modification and physical therapy. When these do not reduce your pain or help you maintain function in everyday opportunities, shoulder replacement surgery is an option.

“Patients should be relatively healthy so they are able to handle the surgery and recovery,” said Dr. Warren Dunn, Marshfield Clinic orthopedic surgeon.

Shoulder replacement surgery options

Patients either receive a total, reverse total or partial shoulder replacement (shoulder hemiarthroplasty). For total shoulder replacements, the surgeon removes damaged parts of the shoulder and replaces it with artificial parts.

Reverse total shoulder replacements are an option when a patient has a severe rotator cuff tear or with arthritis. In a conventional replacement, the ball on top of the arm bone goes into the socket of the shoulder. For a reverse replacement, the ball attaches to the socket, which is placed on the upper arm. This relies on different muscles to move the arm.

A partial shoulder replacement, or should hemiarthroplasty, is where the surgeon replaces the head of the humerus with a prosthetic implant. The shoulder socket (glenoid) remains intact.

“I offer should hemiarthroplasty for patients with an intact cuff that are younger than 65,” said Dr. Dunn.

All three surgeries are generally in an outpatient setting, with one to two nights in the hospital.

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Shoulder replacement recovery

After surgery, conventional total shoulder patients will wear a sling for two weeks. Patients have physical therapy that typically starts after six weeks and goes for about three months and follow a home program for a year. Reverse total shoulder replacement patients are out of the sling at six weeks and are less likely to need ongoing physical therapy.

The goal of shoulder replacements are to decrease pain and increase function.

“We want to help you see a significant improvement in your quality of life,” Dr. Dunn said. “But that doesn’t mean you’ll go back to normal or feel like you did 20 years ago.”

Patients will have lifetime follow up visits with their orthopedic surgeon to monitor for infection, instability and wear and tear.

Technology evolution

Surgeons are beginning to do shoulder replacements using GPS navigation.

“There is so little bone to work with on the shoulder blade,” Dr. Dunn said. “The important thing is to put it in the best bone possible.”

The GPS tracker system helps the surgeon identify the best position to place the implant. During the surgery they can see areas of the shoulder on the display screen that are usually difficult to view. The surgeon uses data and tracking of the joint structure, movement and alignment to complete the surgery with more accuracy. This is one of the bigger technological advances in shoulder surgery in recent years, compared to knee and hip operations that have been using computer-assisted surgery.

Talk to your doctor to find out if a shoulder replacement is right for you.

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