Shoulder replacement

For people with severe arthritic damage to their shoulder, or who have experienced trauma or disease in the joint, a shoulder replacement can help remove their pain and restore function and mobility.

Many people, even those with severe shoulder pain or loss of mobility in the joint, are often not even aware that a shoulder replacement is even possible. A lot of this is down to the numbers carried out, especially when compared to knee and hip replacements; although the numbers are increasing, data on the National Joint Registry show there are 6,000-8,000 shoulder replacements done in the UK every year, whereas 80,000 - 100,000 hip and knee replacements are carried out in the same timeframe.

Unusual as it sounds, even many shoulder surgeons don’t carry out many shoulder replacements, with some data showing that a relatively ‘high-volume’ shoulder surgeon is probably only doing about 10 - 12 a year. I carry out around 45 shoulder replacements every year.

What is shoulder replacement surgery?

The primary goal of any joint replacement anywhere in the body should always be reduce pain; restoring function comes second. The aim of shoulder replacement therefore is to reduce the pain first and foremost and then to return function and mobility to the joint. The results from shoulder replacement surgery are really very good. For older people in particular, the operation can help them to maintain their independence for much longer than they would be able to otherwise.

Total shoulder replacement surgery can be carried out in two main ways – ‘anatomical’ or ‘reverse’.

Anatomical shoulder replacement surgery in essence replaces like for like. The natural ‘ball and socket’ joint of your shoulder is replaced with an artificial joint. This new joint restores friction-free movement, improves the mobility of the joint and reduces any pain and stiffness you’ve been suffering from. This is the preferred option for younger age groups, where the tendons in the shoulder are still good.

As we age, our tendons tend to become a bit weaker and can begin to fail. This means that if we were to carry out an anatomical shoulder replacement the function would often be poor as the joint would still be quite unstable. In these cases, where you don't have a rotator cuff (or have a very poorly functioning rotator cuff and/or arthritis), we would carry out what is known as a reverse shoulder replacement. An artificial ball and socket joint is once again created with metal and plastic, but in this case the metal ball is placed on the socket side of your shoulder, and the plastic socket is attached to the top of your humerus, ‘reversing’ the joint.

This reverse structure changes the biomechanics and geometry of the shoulder. It allows the big muscle on the outside of the joint (your deltoid muscle) to support the joint. The results from this surgery are good, with well over 90% of patients pleased with the results.

In particular, this can be a very helpful operation for people who are losing their independence as a result of their shoulder pain. Sometimes, they may be struggling to look after themselves or their partner properly, sometimes possibly having to start thinking about going into a care home. I have seen a shoulder replacement give people like this a new lease of life. The joy of being out of pain combined with their improved function and mobility really does make a huge difference to their quality and enjoyment of life.

Recovery from shoulder replacement surgery

Before your operation, you will meet with one of our physiotherapists or occupational therapists when you come in for our pre-op assessment. They will talk with you about the surgery and what to expect in terms of recovery. Both types of surgery, anatomical and reverse, have the same kind of recovery and the majority of people these days are able to go home the day after their surgery.

You will usually need to be in a sling for around three weeks after surgery, to let things settle down and start to heal. After that, we will work on getting you to spend more time out of the sling, and this will be done with help from our physiotherapy team.

One of the main challenges with recovery is that the shoulder joint often hasn’t been working or moving properly for a long time before the operation. As a result, the muscles around the shoulder will have become much weaker, so the aim of physiotherapy is to strengthen those muscles, as this helps the stability of the joint. I like to refer to this as ‘waking up’ the muscles again.

If you need to drive, you will usually be able to safely return to driving about 4-6 weeks after your surgery. Regaining full function (or as much function as possible) usually takes around 9-12 months, although any pain you had in your shoulder from arthritis will usually be gone after the surgery. Again, taking any pain away is the immediate concern; restoring function and mobility follows.