An expert guide to shoulder replacement surgery

Opting for shoulder replacement surgery can bring patients long-lasting relief from chronic pain and discomfort caused by arthritis in the shoulder. Before making the decision to undergo a joint replacement, patients are likely to have many queries about the specifics of the surgery and its implications. In this article, leading consultant orthopaedic surgeon Mr Adrian Simons expertly answers commonly asked questions about the procedure itself as well as detailing the recovery process. He also explains what results patients can expect after undergoing shoulder replacement surgery.

When is a shoulder replacement recommended?

Shoulder replacement is a treatment for arthritis in the shoulder. There can be many different causes of that arthritis but the main symptoms that patients complain of are:

• pain in the shoulder, particularly in movement
• difficulty sleeping on the affected side
• a grating sensation or even a grating sound coming from the shoulder (due to the bone rubbing on bone)

Is shoulder replacement surgery painful?

As with any operation, there will be some discomfort afterwards. During the procedure, the anaesthetist applies a brachial plexus block once the patient is asleep. This is an injection of local anaesthetic around all of the nerves as they come out of the neck. This provides really good pain relief for around twelve to twenty-four hours after the operation, when we would expect pain to be at its worst. Once that local anaesthetic block wears off, there is some discomfort which is usually treatable with simple pain killers.

What preparation is necessary before shoulder replacement surgery?

Initially, I would normally see the patient in the clinic and we would arrange simple X-rays to examine the shoulder. This is normally enough to diagnose the arthritis. I also use a three dimensional planning software tool which builds a 3D model of the shoulder in virtual reality, which requires a CT scan. Beyond that, it’s purely a question of making sure the patient is fit to undergo anaesthetic so we do a pre-operative assessment with tests such as chest X-rays and ECGs.

How long does shoulder replacement surgery take?

On average, the procedure takes between seventy and ninety minutes but can take two hours in complex cases. Of course, from the patient’s point of view, there will be half an hour anaesthetic time before the surgery starts or maybe 45 minutes or so once the surgery finishes so the patient will lose track of time for two and half hours or so.

What happens during shoulder replacement surgery?

In addition to the anaesthetist and myself, there is usually an assistant, a scrub nurse and the rest of the theatre team helping out. We usually operate with the patient sat up on the operating table because this helps prevent blood loss. The incision is made over the outer side of the shoulder and the main muscle (deltoid) is split. This allows the ball and socket joint to be removed and replaced; the ball part being replaced with a metal piece and the socket with a plastic implant.

What is the success rate of shoulder replacement surgery?

There are different ways to measure success. Most patients will get ninety-five per cent pain relief. I would never promise anybody that their pain will completely disappear but certainly the vast majority of patients can expect good pain relief.

In some cases, patients have a full range of movement after the surgery but in most cases, movement allows patients to live normally but can be a little limited.

You can also measure success of a joint replacement in terms of how long it lasts. If you have a hip or knee replacement these days, most people would expect it to last for fifteen years. However, shoulder replacement is a newer procedure and so the development process hasn’t been as extensive and therefore inevitably the expectations are different. Currently, we would expect shoulder replacements to last for around twelve years. This is the data we have at the moment but shoulder replacements are constantly undergoing re-evaluation and further design processes.

We would hope that the implants we put in today would last longer than twelve years but obviously, twelve or more years have to go by before we can definitively answer that question.

How long is the hospital stay after surgery?

Most people would go home either the day after surgery or possibly the following day, so one or two days.

In younger patients who are fit and well with no other medical problems, me and my anaesthetist colleagues have been pushing for day case treatment, so they go home the same day. This is something that has been pioneered the US over the last few years and there are now a few units in the UK which are also able to perform day case shoulder replacements but I believe we are the only one in the West Midlands.

So far, we have performed day case shoulder replacements for seven patients who were able to get home on the same day. We had one patient who was so pleased with her first day case shoulder replacement, she came back to have the other shoulder done in the same way.

How long does recovery take?

Patients will be in a sling for about six weeks after surgery. During that time, physiotherapists will encourage you to gently get the shoulder moving, building up strength and a range of movement slowly. After approximately six weeks, patients are usually out of the sling but there will still be some work to do with physiotherapists for at least another six weeks. In total, patients should realistically expect three months of work with a physiotherapist.

In fact, patients tell me that the shoulder does continuously improve certainly for six months after the surgery and there may even be a small improvement in terms of movement and strength up to a year after the surgery.

How well does the shoulder function after surgery?

As I’ve already mentioned, it’s unlikely that you will get one hundred and eighty degrees of movement after the surgery and abductions in an upwards and forwards movement will more likely reach around one hundred and forty to one hundred and fifty degrees. We would expect you to be able to achieve some external rotations twisting outwards but unfortunately, after shoulder replacement surgery it is unusual to be able to get the hand all the way behind the back.

In terms of strength, patients certainly get more strength than they had beforehand because most of the pain has gone. However, I wouldn’t expect patients to be lifting heavy weights after a shoulder replacement.

The outcomes after surgery largely depend on the type of shoulder replacement and the patient’s fitness before undergoing the procedure. Some patients certainly do get back to playing gentle tennis and golf after a shoulder replacement but it does depend very much on the motivation of the patient and their individual case.

If you require shoulder replacement surgery or are worried about the symptoms of arthritis of the shoulder, you can book a consultation with Mr Simons by visiting his Top Doctors profile.