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Partial shoulder replacement

Overview

In both partial and total shoulder replacement surgery, the bone surfaces and cartilage that have been damaged are removed and replaced with artificial surfaces (implants).

In cases where significant damage is limited to only the humeral (ball) side of the joint, your doctor may consider a procedure that preserves the healthy side of your shoulder. This is called a partial shoulder replacement. In a partial shoulder replacement, only one side (the diseased portion) of the joint is replaced, leaving the healthy portion untouched.

A successful partial shoulder replacement can relieve pain and preserve more of your natural anatomy. It may delay, and, in some cases, prevent a more extensive total shoulder replacement, which replaces both parts of your shoulder.

When you need it

When shoulder pain is so bad it actually interferes with the things you want or need to do, the time may be right for shoulder replacement surgery.

Shoulder replacement may be an option when nonsurgical interventions such as medication and physical therapy no longer help alleviate the pain. Other possible signs include:

  • aching in the joint, followed by periods of relative relief
  • pain after extensive use
  • loss of motion
  • joint stiffness after periods of inactivity or rest
  • pain that seems to increase in humid weather

Your primary care doctor may refer you to an orthopedic surgeon who will help you determine when or if it’s time for shoulder surgery and which type of shoulder surgery is most appropriate.

Doctors generally try to delay shoulder replacement for as long as possible in favor of less invasive treatments. However, if you have advanced joint disease, shoulder replacement offers the chance for relief from pain and a return to normal activities.

When it's not an option

Even though shoulder surgery may be an effective way to minimize or eliminate shoulder pain, your doctor may decide that shoulder replacement surgery is not appropriate for you. Reasons could include:

  • You have an infection or a history of infection
  • You don’t have enough bone, or the bone is not strong enough to support a new shoulder
  • You have injured nerves in your shoulder area
  • You have injured or nonfunctional shoulder muscles
  • Your shoulder is severely unstable
  • Your bones are not fully grown or developed
  • You have noticeable bone loss or a severe decrease in bone mass (osteoporosis)
  • Your shoulder joint has been previously fused and is stable, functional, and painless
  • You have rheumatoid arthritis and active/history of skin lesions (due to increased risk of infection)

Risks

Shoulder replacements have been highly successful for years. Many people who have suffered from shoulder pain and arthritis have experienced relief and restored motion through total shoulder replacement. And because new materials and procedures are always being developed, the results continue to get better.

The complication rate following total shoulder replacement is low. Serious complications, such as shoulder-joint infection, occur in fewer than 1.8% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. (Of course, chronic illnesses may increase the potential for complications.)

Every surgical procedure has some risks and benefits. Your individual results will depend on your personal circumstances, and recovery takes time. While there can be no guarantee of success, benefits can include pain relief and return of normal use of the shoulder.

Each of the following reactions or complications can occur during and after surgery and may require medical attention (such as further surgery) and implant removal.

Infection

Infection is a risk with any surgical procedure. According to the American Academy of Orthopaedic Surgeons, 1.8% of patients get an infection in the first two years. When infection occurs after total shoulder replacement, it is most commonly caused by bacteria that enter the bloodstream during dental procedures or from urinary tract, skin, or fingernail infections. Although uncommon, when these complications occur, they can delay full recovery.

For the first two years after your shoulder replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. After two years, talk to your orthopedist and your dentist to see if you still need preventive antibiotics before other procedures.

Osteolysis

The bone next to the shoulder implant may break down (called osteolysis) because of your body’s reaction to particles that may be caused by:

  • Direct contact of the metal and plastic components
  • Contact between the shoulder components and the bone cement
  • Contact between the shoulder components and the natural bone particles that exist between the shoulder’s moving parts, which can cause more particles or damage to the implant components

Implant fracture

Implant fracture has been reported following total shoulder replacement. This is typically caused by:

  • Patients with unrealistic performance expectations
  • Heavy and/or overweight patients
  • Physically active patients

To minimize the possibility for implant fracture, it is important to follow medical instructions and to avoid excessive or inappropriate activity.

Other risks

  • Removal and/or replacement of the device system or its components may be necessary at some point in the future
  • Although rare, metal-allergy reactions from shoulder implants have been reported. Inform your doctor if you have any allergy symptoms
  • Dislocation can result from improper positioning of the implant components or falling down and landing on your shoulder or elbow
  • Implant components can loosen or move due to improper cementing or shock from falls or collisions
  • Cardiovascular disorders associated with the use of bone cement include blood clots, decreased blood pressure, heart attack, and in rare instances, death

Costs

The cost of a partial shoulder implant varies, depending on the type of implant used. Generally, the hospital purchases the implant and includes it as part of the total cost for the surgery. The ultimate cost for shoulder replacement surgery is specific to the hospital where the surgery is performed. Please contact the hospital accounting office to get an estimate of the charges for surgery.

Standard shoulder replacement surgery is covered by most insurance plans. You will need to check with your particular healthcare plan for details.

Questions to ask about this treatment

Here are some questions that may be helpful to ask your doctor when considering shoulder surgery. It’s also a good idea to keep a record of your shoulder pain to share with your doctor at the same time.

  • Do I need to have surgery? If so, do I need it immediately?
  • What would happen if I wait six months? One year?
  • If I need surgery, what complications may occur with this kind of surgery?
  • How many surgeries of this type have you done?
  • What is the expected recovery time from surgery?
  • How many days will I be in the hospital after surgery?
  • Will I have physical therapy? If so, how often and for how long?
  • Will I need full-time or part-time care? If so, for how long?
  • How soon will I be able to resume normal lifestyle activities (e.g., work, sports, housework, gardening, etc.)?
  • Will an implant make it difficult to go through metal detectors?

Preparing for treatment

If you and your surgeon decide that partial shoulder replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will help to ensure that other health problems you may have, such as diabetes or high blood pressure, will be identified and treated before surgery.

Your doctor may suggest that you lose weight and initiate an exercise program. If you smoke, be sure to speak with your doctor about it, as smoking can dangerously increase surgical risks and slow down the healing process.

You should also finish any dental work that may be under way to prevent germs in your mouth from entering the bloodstream and infecting the joint. It is likely that you will need blood during shoulder surgery, and your surgeon may place an order with the blood bank in case a transfusion is needed. If you prefer, or if your surgeon feels it is needed, you may want to donate your own blood ahead of time to reduce the risk of your body reacting to the blood transfusion.

Four weeks before surgery

  • Become familiar with your shoulder anatomy and shoulder replacement surgery. You may find it helpful to understand how your shoulder works and learn about shoulder replacement surgery.
  • Prepare questions to ask your doctor and take them to your next appointment. As your surgeon gives you instructions on how to prepare for surgery, take notes and refer to them once you are home.

Three weeks before surgery

  • Contact friends and/or family for support. You may need help with bathing, dressing, meals, laundry, housework, shopping, and going to your doctor’s office. Contact family members or friends ahead of time to make the necessary arrangements. If you don’t have someone to help you at home, ask your doctor about home caregivers. The Arthritis Foundation also has a support network that can provide emotional support. You can contact your local chapter or go to the Arthritis Foundation Web site (arthritis.org) for more information.
  • Get your home ready for your recovery.
    • Store frequently used items, such as cleaning supplies and canned foods, in easy-to-reach cabinets. Avoid very high or very low shelves as these may require you to reach or pull.
    • Make and freeze meals or stock up on frozen dinners before surgery so that meal preparation is easier and requires less effort. You should plan on making enough meals for one week or so.
    • Check the safety of your home to prevent falls or tripping. Move long electrical and telephone cords against the wall, remove rugs, and place a non-skid mat in your bathtub.

Two weeks before surgery

  • Avoid anti-inflammatory medications. Your surgeon may not want you to take any aspirin or non-steroidal anti-inflammatory medications (Advil, Ibuprofen, Motrin, etc.) for the 14 days before surgery. You may be able to take Tylenol or medicines with acetaminophen. Be sure to discuss this with your surgeon.
  • Purchase or borrow the special equipment your surgeon recommends. This may include a sling and small devices such as a grabber. You can find these items at most hospital supply sections of large drug stores or in mail-order catalogs from department stores. Practice using the items at home.

One week before surgery

  • Write down all of the medication you take, the dose, and how often. You will want to take this list with you when you pre-admit at the hospital.
  • Preregister at the hospital. Your surgeon may suggest that you pre-admit to the hospital, typically three to nine days before your surgery. Your insurance will be verified, and depending upon your surgeon’s instructions, you may have lab work, X-rays, and an EKG. You may want to plan at least two-and-a-half hours to complete the visit. Check with your surgeon to see if an appointment is necessary. You may receive a breathing exerciser. The nurse will review written directions for the exerciser with you. Bring a list of the medicines you are currently taking; this includes the name(s), the dose(s), and how often you take the medication. If you have blood slips from blood you or your family have donated, bring the slips with you and give them to the nurse in the admissions area. You may also see someone from the anesthesia department to discuss anesthetic.
  • Manage your finances. You may want to balance your checkbook, pay bills, make arrangements to board pets, and stop the delivery of your newspaper.
  • Contact local supermarkets and pharmacies. Call supermarkets and pharmacies to see if they provide delivery services and if they charge a fee. This will make it easier to avoid having to lift heavy grocery bags.
  • Go to the supermarket. Make a list of the items you may need once you return from the hospital, and purchase these items or arrange for the supermarket to deliver them to your home.

Week of surgery

  • Pack for the hospital. Below is a list of things you may want to bring with you to the hospital in preparation for your surgery. Your personal belongings should be left in the car or with family members until after surgery. Your room will be assigned when you are in surgery or in recovery, at which point they can bring you your personal items.
    • Personal grooming items such as a toothbrush, toothpaste, hairbrush, eyeglasses/contacts, comb, deodorant, shaving cream/electric razor, shampoo, lotion, undergarments, and a robe
    • Slippers or flat rubber-soled shoes for walking in the hallways
    • Loose fitting clothing and a shirt that opens in the front for your trip home
    • Medications you are currently taking. You should also write down your medication information for the hospital staff; be sure to include the name, strength, and how often you take the medication. Tell your doctors and the nursing staff about any allergies you might have
    • If you use a breathing exerciser (IBE), be sure to bring it with you from home, as you will probably need this right after surgery; check with your surgeon about this
    • Leave jewelry, credit cards, car and house keys, checkbooks, and items of personal value at home; bring only enough pocket money for items such as newspapers, magazines, etc.

Day before surgery

  • Don’t eat or drink anything after midnight. Eating or drinking after midnight will most likely not be allowed by your surgeon (not even water) the night before your surgery. Check with your physician about this. Your anesthesiologist may prescribe a medication for you to take the evening before surgery.

Preparing your home

A little time spent getting your home ready before your surgery can make a big difference in your recovery. Here are some helpful hints for around the house:

House in general

  • Remove throw rugs and tack down loose carpeting to help avoid falls
  • Remove electrical cords, telephone cords, toys, and other tripping hazards
  • Provide good lighting
  • Cover slippery surfaces with carpets that have nonskid backs
  • Place regularly used items such as remote controls, medications, and reading materials in convenient and easy-to-reach locations

Kitchen

  • Stock up on canned and frozen foods
  • Prepare meals ahead of time and freeze them
  • Store food in a cupboard that’s at waist level
  • Place frequently used cooking supplies, pots, pans, plates, and utensils on the counter or where they can be easily reached

Bathroom

  • Stock up on toilet paper, shampoo, toothpaste, medications, and other personal items
  • Place a slip-proof mat in the shower
  • Install a nightlight

Bedroom

  • Wash all your towels, linens, and dirty clothes
  • Place loose clothing and pajamas in waist-level drawers or closets
  • Install a nightlight

Other

  • Make sure you have easy access to a phone. Consider using a cordless or cell phone
  • Reachers and grabbers will come in handy
  • Avoid clothes that you need to pull over your head; loose-fitting clothes that open in the front will make getting dressed easier
  • Rent/buy/borrow plenty of books, movies, music, and puzzle books 

What to ask before beginning treatment

Here’s a list of questions that may be helpful to ask your doctor before your shoulder surgery.

  • What complications may occur with this kind of surgery?
  • What is the expected recovery time?
  • How many days will I be in the hospital after surgery?
  • Will I have physical therapy? If so, how often and for how long?
  • Will I need full-time or part-time care? If so, for how long?
  • When can I lie on the operative side?
  • When can I shower after surgery?
  • How soon will I be able to resume normal lifestyle activities (i.e., work, sports, housework, gardening, etc.)?
  • Which sports may I participate in?
  • What are lifting limits?
  • When is sexual intercourse feasible after surgery?
  • Will I set off the metal detectors at the airport?
  • Will I need antibiotics for dental care?
  • What is the implant made of? Which biomaterials will be used?
  • In your estimate, how long will my joint replacement last?
  • What can I do to help keep my joint replacement functioning as long as possible?
  • What activities or other factors could make my joint replacement wear out more quickly, and what can I do to avoid them?

What to expect the day of treatment

Shoulder replacement surgery is the same idea as having most things fixed—worn parts are taken out, and new parts are installed in their places. In shoulder surgery, the damaged portions of the shoulder bones are removed, and the shoulder is replaced with metal and plastic implants. Here’s what you can expect on a typical day of shoulder surgery.

  • A small tube (intravenous line) is inserted into your unaffected arm. This tube is used to administer antibiotics and other medication during your surgery.
  • You’re taken to the operating room and given anesthesia.
  • Anesthesia takes effect, and your shoulder is scrubbed and sterilized with a special solution.
  • Your shoulder replacement surgery will likely take between one and three hours and begins with an incision over your shoulder to expose the joint.
  • Bones are fully visible to the surgeon, and special, precision guides and instruments are used to remove the damaged surfaces and cut the humeral head (ball) and prepare the bone to accept the implant.
  • The new implant is inserted.
  • If your socket is to be replaced, its damaged surface is smoothed and a new plastic surface is inserted.
  • The ball and socket are checked for fit and function.
  • When the surgeon is satisfied, the incision is closed and covered with dressings.
  • A sterile bandage is applied.
  • Your arm is put in a splint and may also be wrapped in an ice pack to help control pain and swelling.
  • You’re taken to the recovery room, where you will be closely monitored.
  • Anesthesia wears off, and you slowly regain consciousness. A nurse is with you and may encourage you to cough or breathe deeply to help clear your lungs. You’re given pain medication.
  • You are fully awake and are taken to your hospital room.
  • Your shoulder remains swollen and tender for a few days.

What to expect when recovering from treatment

The first 24 hours after shoulder surgery

Rehab begins quickly. When you are back in your hospital room, you’ll begin a gentle rehabilitation program to help relax the muscles around your new shoulder. You may be encouraged to get out of bed and take a few steps, and you’ll continue to receive pain medication as needed.

The rest of your hospital stay

Before you are dismissed from the hospital, your physical therapist will show you how to perform the rehabilitation exercises that are important for your recovery.

You’ll be discharged as soon as your surgeon determines that you have recovered sufficiently. You can expect to stay in the hospital for about three days after your surgery. Your bandages and sutures will usually be removed before you leave.

Tips for when you’re at home

At home, you’ll need to continue your exercises. Your physical therapist will instruct you about proper home care and may continue to work with you. Your shoulder area may be warm and tender for several weeks. It is important to remember that while you are recovering, you should not lift more than one pound with the operative arm.

Here are some suggestions that may make life a little easier at home. Please discuss these with your surgeon and/or physical therapist.

  • Do not use your surgery arm when getting out of bed or up from a chair. Use the opposite arm.
  • You may be advised not to pull anything to you, such as pulling up pants and opening doors, for six weeks after surgery.
  • Your doctor will likely give you a list of exercises to do once you’re home. Be certain to follow your doctor’s instructions, but typically you will be asked to do these exercises four or five times a day for a month or so.
  • Be certain not to exceed the range of motion restrictions given by your physician.
  • Be careful to avoid falls.
  • You may experience less pain after surgery, which may make you believe you can do more. Be certain to follow your doctor’s instructions so that you don’t overdo it.
  • The amount of weight you can lift using your surgery arm will be limited. Your doctor may recommend that you don’t lift anything heavier than a cup of coffee for the first four to six weeks.
  • Sling use will vary depending upon the situation, but your doctor may request that you wear the sling every night for at least the first month.
  • You will likely need to avoid contact sports after surgery. Your doctor will discuss these restrictions with you.
  • Remember that you will probably tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes mid-morning and mid-afternoon.
  • Avoid many household chores, such as raking, sweeping, mopping, and running the vacuum cleaner using your surgery arm. Use long-handled feather dusters for dusting high and low items. Your doctor will tell you when it is okay to do these activities.
  • Constipation is a common problem for patients following surgery. This is usually due to your limited activity and any pain medications you may be taking. Discuss your diet with your doctor. It should include fresh fruits and vegetables as well as eight full glasses of liquid each day, unless your doctor tells you otherwise.
  • Your doctor will probably give you a prescription for pain pills. Please follow your doctor’s instructions concerning these medications.
  • Some swelling around the incision is normal. You will find it more comfortable to wear loose clothing to avoid pressure on the incision. Ask your doctor or other qualified health professional about appropriate wound care.
  • You may want to place a pillow behind your elbow when seated or lying down to keep the surgery area forward to help decrease pain.
  • Your doctor may recommend that you apply ice to your shoulder to help decrease pain. A two-pound bag of frozen peas or other small vegetables works surprisingly well as an ice pack.

Making a full recovery

In the months following your shoulder surgery, you’ll most likely be advised to take it easy and modify your positioning to keep pressure off of your shoulder. While you are recovering, you should not lift more than one pound with the operative arm.

In most cases, successful shoulder replacement surgery will relieve your pain and stiffness and allow you to resume many of your normal daily activities as instructed by your doctor. But even after you have fully recovered from your surgery, you will still have some restrictions.

Once you’ve had your shoulder replaced, normal daily activities no longer include contact sports, “jamming” activities such as hammering, heavy or repetitive lifting, or activities that put excessive strain on your shoulder. Your doctor may advise you not to lift anything that weights more than five pounds. Although your artificial joint can be replaced, a second implant is seldom as successful as the first.

For the first two years following your shoulder replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. After two years, talk to your orthopedist and your dentist or urologist to see if you still need preventive antibiotics before any scheduled procedures.

How to make your treatment last

The longevity of prosthetic shoulders varies from patient to patient. It depends on many factors, including your physical condition and activity level, as well as the accuracy of the implant placement during surgery. It is useful to keep in mind that prosthetic shoulder joints are not as strong or durable as a natural, healthy shoulder joint, and there is no guarantee that your shoulder replacement will last the rest of your life.

Talk with your doctor about the following points, and how they might affect the longevity and success of your shoulder replacement:

  • Avoid repetitive lifting
  • Avoid lifting anything heavier than one pound during recovery; and avoiding lifting anything heavier than five pounds after recovery
  • Avoid “jamming” activities such as hammering
  • Stay healthy and active
  • Avoid “impact loading” sports such as boxing
  • Consult your surgeon before beginning any new sport or activity to find out what type and intensity of sport or activity is appropriate for you
  • Think before you move
  • Avoid any physical activities involving quick stop-start motion, twisting, or impact stresses on the operative shoulder
  • Avoid pushing heavy objects
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