Shoulder & Elbow : Shoulder Replacement

David Potter explains "What is a shoulder replacement?"

There are two types of shoulder replacement which may be offered to you:

1. “Total shoulder replacement”
2. “Hemiarthroplasty”

A total shoulder replacement is an operation to replace the “ball and socket” components of the
shoulder joint.

The ball component is known as the humeral head, which sits at the top of the arm bone (humerus).

The socket is known as the glenoid fossa, which is part of the shoulder blade (scapula).

The humeral head is removed and replaced with a metal implant, and the glenoid fossa is also shaved and resurfaced with a polyethylene (plastic) cup to provide the bearing surface.

A hemiarthroplasty replaces just the ball of the shoulder joint.

What are the benefits of having a shoulder replacement?

A shoulder replacement is often advised when there are severe degenerative changes in the shoulder joint, such as arthritis, causing pain and reduced movement.

  • Osteoarthritis is “wear and tear” arthritis, which can damage the joint surfaces.

  • Rheumatoid arthritis is another type of arthritis, whichcan effect many joints in the body including the shoulder, resulting in pain and reduced movement. It is normal to experience some pain after the operation but a shoulder replacement can relieve a lot of the pain previously experienced. In addition, there may be some improvement in the range of movement of your shoulder, but this largely depends upon the condition and strength of your muscles before surgery. It is unlikely you will get as much movement as in a normal shoulder but due to the decreased pain you may be able to carry out functional activities more easily.

Are there any complications in having a shoulder replacement?

As with most types of surgery there are risks involved and complications can occur which are unrelated to the shoulder replacement.

Some of the complications which can occur rarely with a shoulder replacement are:

1. infection
2. the new joint becoming loose
3. damage to the nerves
4. dislocation
5. fracture

These risks are very small but if any occur, further treatment or an operation may be necessary.

1. Infection can be a very serious complication - it is thought that the risk of developing an infection is about 1%. Some infections show up immediately whilst you are still on the ward, others are not apparent for months. Due to this risk your surgeon may recommend you take antibiotics, if you have dental work or other surgery, to prevent any infection spreading to your new joint.

2. Loosening is a main reason why joint replacements can eventually fail. It is a process that occurs where the metal or cement meets the bone. Most will eventually loosen and require revision, as loosened joints are painful. On average you can expect your shoulder replacement to last about 10 - 15 years.

3. Nerve damage can occur during the surgery as many of the large nerves and blood vessels that enter the arm pass very close to the site of the operation. Damage can be temporary if retractors holding them out the way stretch them; it is rare that permanent damage can occur, but is possible.

4. Dislocation of the new shoulder joint is a possibility after surgery, before the tissues holding the joint in place have healed fully. Your therapist will show you which positions to avoid in order to minimise the risk.

5. A fracture during surgery is very rare, but if this happens, you may require additional surgery or a
slightly different prosthesis. There is a small risk of a periprosthetic (below the metal work) fracture after surgery, which are most likely following a fall.

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