What is shoulder replacement? Many patients have asked about shoulder replacement, wondering if they are a candidate for this procedure. There are several causes of shoulder pain, and not all shoulder pain requires surgery.
The shoulder and its components
The shoulder is a complex joint. It is considered a ball and socket joint, similar to the hip joint. However, the socket for the shoulder is very shallow. The shallow socket allows our shoulders to have such incredible range of motion. This same range of motion makes the shoulder intrinsically unstable. The shoulder is highly complex, with multiple tendons and structures that make movements possible. This complexity means there can be several causes of shoulder pain.
When a patient presents to the orthopedic clinic for shoulder pain, we look for these different sources:
- Rotator cuff tendonitis, bursitis or a tear
- Neck pathology
- Labrum tears
- Shoulder joint arthritis
- Combination of rotator cuff tear and arthritis
Assessment and treatment
We use medical history, a physical examination, x-rays and occasionally an MRI or CT scan to help us understand the cause of the pain. Shoulder arthritis and a combination of a rotator cuff tear and shoulder arthritis are the main indications for shoulder replacement. Before considering surgery, we explore other options like medication, steroid injections, activity modification and physical therapy.
When conservative measures are not helping, then we consider surgical treatment. Surgical treatment includes a total shoulder arthroplasty (shoulder replacement) or a reverse total shoulder arthroplasty. The difference between these two surgeries involves the ball and socket. When a patient has arthritis of the shoulder joint with a rotator cuff that is intact and functioning well, we can do a standard shoulder replacement. For this type of surgery, we attach a small shallow plastic socket to the worn-out socket. We remove the worn-out ball and replace it with a new metal ball attached to a stem. This new ball and socket joint is still unstable, so we rely on the functioning rotator cuff to provide stability, just like a healthy shoulder. This allows for a nearly normal, pain-free range of motion and strength.
We cannot do a standard shoulder replacement when a patient has arthritis combined with a large irreparable rotator cuff tear. In these cases, we do a reverse total shoulder replacement. This surgery involves attaching a ball to the worn-out socket and removing the worn-out ball, then replacing it with a deeper socket. This replacement creates a more stable ball and socket joint. It also allows the ball to become the fulcrum so the arm can rotate. It alleviates pain and improves function. The trade-off with a reverse total shoulder replacement is reduced range of motion. Therefore, we do this surgery only when the rotator cuff is not functional or repairable.
The surgery usually takes a little over an hour, so most patients spend one night in the hospital and are discharged the next day. Recovery involves six weeks of physical therapy. The patient has to wear a sling during recovery. Following this initial period of immobilization, we progress to active range of motion, then strength conditioning. Total recovery time is approximately 4-6 months. Most patients feel their pain is improved within a few days to weeks.
About the author
Ben Robertson, M.D. is an orthopedic surgeon at Tri-County Health Care serving patients in Wadena and Baxter. He attended medical school at the Medical College of Wisconsin and completed his residency at the University of Minnesota. Additionally, he also completed a sports medicine fellowship in Oslo, Norway. He specializes in sports injuries, knee ligament reconstruction, and shoulder, hip, and knee replacement. Outside of work, Dr. Robertson enjoys bicycling, reading and spending time with his wife and three children.