You've Just Been Told You Need a Shoulder Replacement. Here Are Answers To Questions You Forgot To Ask.
If you've seen Dr. Jurek or another orthopaedic shoulder surgeon who has recommended that you consider undergoing shoulder replacement surgery, here are answers to some questions you may have:
What exactly IS a shoulder replacement?
A shoulder replacement is a surgery that replaces the surfaces of a worn out or injured shoulder joint with very smooth, strong metal and plastic surfaces to treat severe shoulder pain and improve function of the shoulder.
Shoulder replacement surgery is considered an "open procedure" meaning that a small incision (usually measuring about 5 inches in length) is made and the surgery is performed through that incision.
There is more than one different type of shoulder replacement; the most common are 1) anatomic total shoulder arthroplasty and 2) reverse total shoulder arthroplasty.
Reverse total shoulder arthroplasty is something entirely unique to the shoulder and switches up the anatomic relationships completely. Another term for this surgery is "inverse articulation surgery" but most people just refer to it as a "reverse." In reverse total shoulder replacement surgery, the ball of the shoulder joint (the humeral head) is replaced with a metallic socket component and the socket/cup of the shoulder joint (the glenoid) is replaced with a metallic ball (also called a "glenosphere"). There are special circumstances when a reverse total shoulder arthroplasty is a better option (and sometimes, the only viable option) as a replacement. This is something Dr. Jurek will discuss with you at length if shoulder replacement surgery is recommended to you.
Why do I need a shoulder replacement?
There are many reasons why shoulder replacement surgery may be an excellent option for you.
One of the most common reasons why you need a shoulder replacement is that you have very severe arthritis of your shoulder and nonoperative treatment no longer adequately addresses your symptoms.
Many patients decide to have their shoulder replaced when they are having significant difficulties sleeping and/or doing their normal daily activities because of severe shoulder pain.
Other common reasons why shoulder replacement surgery is performed include: 1) treatment of certain shoulder fractures, 2) treatment of a shoulder with very large, irreparable rotator cuff tear (termed "cuff tear arthropathy") with severe shoulder pain and weakness, and 3) treatment of something called "avascular necrosis," which is when the blood supply to the shoulder fails and the bone dies as a result, causing severe shoulder pain.
What in the world is a reverse?? Why is it called that?
The first reverse shoulder arthroplasty was performed in France in 1985 by Dr. Paul Grammont and the first reverse replacement was performed in the US in 2004.
Will I be in a sling after surgery and if so, for how long?
The short answer is: yes, you will be in a sling after shoulder replacement surgery. The longer answer is: the length of time you will be in a sling postoperatively depends on which type of shoulder replacement surgery you undergo.
If you have anatomic total shoulder replacement surgery, Dr. Jurek will have you protect your shoulder in a sling for approximately 6 weeks. This time period allows the subscapularis tendon to heal which is very important in achieving a successful outcome.
If you have reverse total shoulder replacement surgery, Dr. Jurek will have you protect your shoulder anywhere from about 10 days to 4 weeks after surgery. The reverse allows a slightly more aggressive postoperative recovery program in general as compared to an anatomic total shoulder replacement.
When do I start physical therapy after a shoulder replacement?
When can I go back to work after a shoulder replacement?
Do I need to stay in the hospital overnight after my surgery?
The short answer to this question is: maybe.
The answer depends on a couple of factors:
1. Your particular health history and status. If you are very healthy and do not have any medical problems that would potentially require care in a hospital after surgery, you may be a good candidate for same day shoulder replacement surgery. On the other hand, if you have medical issues such as heart disease, diabetes, high blood pressure, or lung disease, it may be safest and best to perform your surgery in the hospital and have you stay overnight to ensure that you are safe to return home.
2. Your insurance. While this is slowly changing, many insurance companies will only cover a shoulder replacement surgery if it is performed in a hospital and the patient stays overnight. There are more and more insurance companies who recognize that certain patients do very well having their shoulder replacement surgery performed in a surgery center where they are able to go home the same day after their procedure.
3. Your preference. Some patients feel very strongly about either staying in the hospital overnight or going home the same day as surgery. Dr. Jurek will talk with you about your preferences and together you will come up with a plan tailored specifically to you and your situation.
If I have a shoulder replacement, will I set off metal detectors at the airport?
What will I be able to do once my shoulder is healed after having a replacement and more importantly, what won't I be able to do?
Once your shoulder is healed following shoulder replacement surgery, you will be able to do pretty much everything you want to do with your shoulder with a few important caveats. Especially initially, you may have some shoulder stiffness that will take time to resolve. It is possible that you may always have some limitations in range of motion following shoulder replacement surgery but usually these limitations do not compromise function or quality of life.
While Dr. Jurek does not put a discrete weight limit on how much you can lift after shoulder replacement surgery, you should not engage in heavy weight-lifting or repetitive high impact activities such as chopping wood following shoulder replacement surgery as this can cause loosening or failure of the implants. If you gradually build up the amount that you lift with your replaced shoulder, it is safe to lift heavy objects as long as you are able to safely control the load and protect your shoulder.
I want to discuss a condition that I frequently diagnose and treat in my clinic and for which I have a particular fondness and focus within my orthopaedic surgery practice: shoulder arthritis. I have many patients who come to see me with shoulder pain who are a.) very surprised to find out that they have shoulder arthritis and b.) are even more surprised to find out that there are excellent treatment options available to treat shoulder arthritis.
The shoulder joint (termed the “glenohumeral joint” in medical nomenclature) is the third-most common large joint affected by degenerative joint disease (knee and hip arthritis are more common). There are multiple types of shoulder arthritis and all of these ulitmately result in a wearing away of the "cushion" of the joint, the smooth outer covering of the bone known as the articular cartilage. As the cartilage wears away, the protective space within the shoulder joint narrows and the cartilage becomes rough and frayed and eventually wears completely away. This results in the bones of the shoulder joint rubbing against each other, causing pain. Because of the increased pressure on the surfaces of the bone, there can be structural changes that gradually occur within the shoulder including the formation of bone spurs (termed "osteophytes") and changes of the shape of bones of the shoulder. Although there is no cure for shoulder arthritis, there are many treatment options available. The goals for treatment are to manage pain and to allow you to remain active.
Pain is the most common symptom of arthritis of the shoulder and it is exacerbated by activity. The natural progression is for the pain to worsen over time, although how rapidly the pain progresses is unique to each patient. With shoulder arthritis, the pain is typically centered deep within the shoulder and may intensify with weather changes. Patients typically describe their pain as a deep ache, which worsens with activity.
Other symptoms include limited range of motion, sensations of clicking, grinding, and or snapping with movement of the shoulder, and, as the disease process progresses, pain at night which causes significant difficulty with sleep.
Initial treatment of shoulder arthritis is nonsurgical and includes options such as:
If your pain from your shoulder arthritis is not adequately addressed with the nonoperative treatments above then surgery is the next treatment step and usually consists of shoulder replacement surgery. There are multiple different types of replacements available and I will spend a lot of time talking with you about which option is the most appropriate to address your specific situation.
Briefly, the replacement surgery options include:
If you are having shoulder pain, consider scheduling an appointment to find out what is causing your pain and the best treatment(s) for you.
Sara Jurek, MD