10 April 2018
1. What is shoulder replacement surgery?
Arthritis can affect the shoulder joint in the same way it does the hip and knee joints. When the surfaces of the shoulder joint become rough and inflamed, causing stiffness, clicking or creaking and pain we can replace them using the same techniques as used in hip and knee replacements.The surface of the ball of the shoulder (the humeral head) is replaced with a metal or ceramic hemisphere attached to a stem, which is impacted or cemented into the upper part of the arm (the humerus). The surface of the socket (the glenoid) is replaced with a thin plastic (polyethylene) washer attached to the shoulder blade with cement or a metal back-plate. The two new surfaces articulate with each other smoothly, giving better movement and less pain. If the muscles of the shoulder joint (the rotator cuff muscles) are healthy and can be exercised gradually to become stronger then the new shoulder joint will be stable and function well. This form of shoulder replacement is called an ‘anatomic shoulder replacement’ because it mimics the normal form of the shoulder joint. If these muscles are not healthy, or cannot be repaired then a slightly different type of shoulder replacement is used called a ‘reversed replacement’. This sort of shoulder replacement does not give quite as good movement as the normal variety, and has more potential complications.
2. How long would a shoulder replacement last?
An anatomic shoulder replacement generally lasts between 10 - 15 years, unless the rotator cuff muscles wear out, in which case the shoulder replacement may become weaker, less stable, uncomfortable and lose some movement. If these problems become intrusive then revision of the shoulder replacement is possible. The results of revision total shoulder replacement are not as good as in the first instance. Our current knowledge of the long-term survival of reversed replacements is less confident: weakness of the large muscle of the shoulder (the deltoid muscle) can occur and this can limit the function of this sort of shoulder replacement after about seven to ten years.
3. How long until I can drive and return to work/normal day to day living?
We think of the return to normal activities in terms of what is necessary for personal care (movement around the waist and up to mid-chest level), what is necessary for domestic use (movement away from the body, for instance preparing food in the kitchen) and movement necessary for social activities (such as driving). We would expect someone with a new shoulder replacement to be able to care for themselves by the end of the first six weeks after the operation. Domestic activity should be possible and safe by the end of the third month after surgery, and most people who work in an office type setting will be back at work. Driving should be possible around this time too. Activities such as non-impact sport, including gym-based exercises, can be started at this time and built up over the next three months. Golf, for instance, can be safely started by six months after the operation. Tennis, sailing, and other sports requiring strong reaching movements of the shoulder may have to wait until beyond six months after surgery.
4. How much physiotherapy would I require?
Physiotherapy is helpful to support and guide return to good function over the first three months after surgery. In the first period (the first six weeks) simple exercises are carried out at home, and only one or two visits to the physiotherapist are needed, unless there is uncertainty about how to do the exercises. From six weeks to three months after surgery weekly visits are helpful to gain and maintain motion, strength, and stability in the shoulder. Cardiovascular exercises are restarted at this time, but weight-training should be deferred until your physiotherapist recommends that it is safe to return (usually at about three months after surgery).
5. How would I get dressed after surgery?
The rule (for all shoulder - and elbow - surgery) is ‘operated arm in first, out last’. Simple garments that are not fastened with small buttons, awkward zips, or fiddly clips should be worn. Loose tops that can be pulled off over the head and loose fitting jogging trousers with fastenings at the front are helpful in the first six weeks. Slip-on shoes are preferred, particularly if you have little help at hand. A sling is worn for at least six weeks, and you will have been taught by your physiotherapist how to put this on and take it off for bathing safely: it is generally worn outside your clothes.
Mr Simon Lambert is a Consultant Shoulder and Elbow Surgeon at Spire Bushey Hospital.
For more information on shoulder replacements click here.