Shoulder and elbow joint replacement: an assessment: part 2

In the second article of a two-part series, consultant orthopaedic surgeon Mr Dave Cloke discusses the success rates of shoulder and elbow joint replacement surgeries, and what to expect from post-surgery rehabilitation.

What are the success rates of shoulder and elbow joint replacement surgeries, and how long is the recovery period?

When it comes to the recovery process following shoulder or elbow replacement surgery, I typically advise the patients to prepare for a period of discomfort and stiffness lasting several weeks. By approximately three months post-surgery, patients can expect to experience gradual improvements in both movement and pain, with progress accelerating over the subsequent three months. Between six months and one year, recovery tends to proceed steadily, with ongoing enhancements. Research indicates that by the one-year mark post-operation, patients generally achieve their maximum level of improvement.

Shoulder replacement

A relatively simple estimate would be that a shoulder replacement should provide about a 90% chance of enjoying a highly functional and comfortable shoulder for up to 10 years. Short-term risks include infection, nerve and blood vessel damage, and dislocation. However, overall pain relief and improved mobility are typically experienced within the initial months. Over time, there's a heightened risk of joint-related issues, mainly due to the wear and tear on the metal and plastic components of most replacements.

Generally, modern replacements offer a 90% satisfaction rate for up to 10 years. Beyond that, the likelihood of encountering problems increases. Unlike hip and knee replacements, some individuals with painful shoulder replacements may opt against further surgical intervention, despite ongoing discomfort.

There are a few considerations to keep in mind. Younger individuals, especially those under 50, undergoing shoulder replacements have a higher likelihood of requiring additional surgeries, partly due to their longer life expectancy and increased joint activity. Additionally, partial replacements may accelerate wear on the remaining socket, potentially requiring further surgery sooner. Nonetheless, addressing such issues typically isn't as complex as dealing with total joint replacements.

Elbow replacement

For older, lower-demand patients with inflammatory arthritis, it is estimated that 90% will have a good elbow 10 years post-operation. However, this statistic is significantly lower in younger people with osteoarthritis and in men. Elbow replacements primarily function as small hinge joints, susceptible to stress-related issues. Therefore, the more strenuous activities performed and the longer they persist, the greater the risk of encountering difficulties with the replacement.

Are there specific conditions or symptoms that indicate a need for shoulder or elbow joint replacement?

Joint replacement surgeries are offered for patients with arthritis of the joint, where pain persists despite other treatment approaches. Naturally, each individual's perception of pain is variable, and it comes down to a personal choice regarding surgery, balancing the chances of prolonged pain relief against the risks of the operation.

What can patients expect in terms of post-surgery rehabilitation and ongoing care following a shoulder or elbow joint replacement?

Following surgery, most patients will undergo postoperative physiotherapy aimed at enhancing mobility, and strength, and reducing pain and swelling. Typically, stiffness and pain diminish significantly within the initial weeks post-surgery. By the three-month mark, many patients report satisfactory pain relief, with continued improvement up to six months. Between six months and one year, most patients perceive that the shoulder has largely improved back to a normal level of pain and movement.

Regarding ongoing follow-up, there is some debate. Modern joint replacements have shown consistent pain relief beyond 10 years, suggesting that regular check-ups may not be necessary. Once patients reach a level of satisfaction with their joint replacement, usually within six months to a year, it's reasonable to discharge them, with the understanding that they can seek reassessment if pain or movement issues arise.

If you would like to book a consultation with Mr Cloke, do not hesitate to do so by visiting her Top Doctors profile today.