What is shoulder arthritis?

Shoulder arthritis is the loss of cartilage lining of the ball in the ball and socket joint of the shoulder. Cartilage is lubrication between the two bones that help the joints and the bones move smoothly. Cartilage wearing down leads to arthritis. In the same way that you can get arthritis in the hips and knees, you can also get arthritis in the shoulders. Arthritis causes patients to have pain, decreased motion, and mechanical symptoms such as grinding or popping as they move the shoulder.

What are treatments for shoulder arthritis?

It’s important to give patients a full range of treatments from non-operative to operative, and to exhaust all non-operative treatments before we discuss surgery.

Non-operative treatments

  • Observation: If the arthritis is not bothering you too much, we can monitor your symptoms and not take action.
  • Physical therapy or home exercises: May help with symptoms, but as arthritis advances they may become less impactful.
  • Medications: Both prescription and over-the-counter anti-inflammatories are available. Not all patients can take them, depending on other types of medical conditions, but anti-inflammatory medications are a go-to medication to help arthritis symptoms.
  • Steroid injection: A steroid injection into the shoulder can help calm down inflammation and give pain relief, although it will not help with cartilage loss.

Surgical treatments

Surgery is the last option if the pain is still debilitating after the non-operative treatments. Surgery is a quality-of-life decision: if you feel you can no longer live with the pain, trying surgery is a reasonable option.

The most reliable outcome of shoulder replacement is pain relief. Motion, or how much you can move your shoulder, is less reliable after surgery and depends on how much motion you have before surgery.

There are two types of shoulder replacement, anatomic and reverse. The major difference between them is the status of the rotator cuff. The rotator cuff is the muscles and tendons around the shoulder that give stability to the shoulder, allow you to move the shoulder and give you strength.

  • Anatomic shoulder replacement
    • Used with an intact rotator cuff
    • Replace the ball with a metal ball and replace the socket with a plastic liner
  • Reverse shoulder replacement
    • Used when the rotator cuff is not working
    • Replace the ball with a socket and replace the socket with a ball, swapping the pieces

How do you prepare for shoulder replacement surgery?

Preoperatively, I typically will have you get a CT scan. The CT scan allows me to do the surgery in a computer before we do it in the OR, which allows us to look specifically at your bone and determine which pieces we will likely use to fit your body. Through the software we can also create a guide to use during surgery to give a more accurate trajectory.

Another major part of preparing for surgery is making sure the surgery is safe. You’ll need medical clearance from your primary care provider and possibly from other specialists before you have surgery.

How do you recover from shoulder replacement surgery?

If patients are doing well and pain is well-controlled, they can go home the same day. If their pain is not well-controlled, they may spend the night in the hospital for one night.

Physical therapy is an important component to surgery. You’ll do physical therapy for three to four months to avoid stiffness and get your motion and strength back.

Most patients will be wearing a sling for four to six weeks after surgery while some of the soft tissues recover and early healing takes place.

Returning to activity depends on your goals, but is usually within three to four months. When you’re trying to do a physical activity, start with an easier version. For example, golfers should just practice putting or chipping before they’re going out and trying to hit their driver 330 yards.

Frequently Asked Questions

How long after a shoulder replacement before you’re allowed to drive?

Before you can drive, you’ll need to be off narcotic medication for at least 24 hours. I also advise against driving while you’re wearing a sling.

When you go back to driving, act like you’re driving for the first time: go out to a big parking lot where you can practice the basics again and make sure it’s safe not only for you but also for other people who are driving on the roads.

If someone needs to have both shoulders replaced, how long do they wait between the two surgeries?

It’s important to make sure you have enough time to rehab the first shoulder, so about three to four months between the surgeries. Bilateral shoulder arthritis (arthritis in both shoulders) is not uncommon, and people who have it usually have surgery on the shoulder that bothers them more first. Other people like to do the dominant shoulder first so that arm can help them in their recovery with the non-dominant shoulder.

Can someone who gets a shoulder replacement be independent right away, or will they need assistance as they recover?

It’s important to talk with your surgeon before surgery about who you live with and what type of help you may need after surgery. It’s always helpful to have someone at home with you for at least the first couple of weeks to make sure you’re doing OK. With your arm in a sling you’re relying on one shoulder, which can be more limiting than many people realize before they have shoulder surgery.

If someone with an anatomic shoulder replacement tears their rotator cuff, would they then get a reverse replacement?

Yes, they would. The anatomic total shoulder relies on the rotator cuff. If the rotator cuff were to fail, that could lead to a similar type of arthritis as someone that has the rotator cuff not functioning to begin with. It might lead to that anatomic total shoulder failing and potentially needing to be revised to a reverse total shoulder.

We always talk about risks and benefits of a surgery before surgery, and the rotator cuff failing is one of the potential risks with an anatomic shoulder replacement and one we discuss before you have the surgery.

How can someone prepare for a shoulder replacement? Are there exercises to do ahead of time?

The stronger you can go into a surgery, the stronger you come out of it. Some people struggle with exercises or physical therapy before surgery because the shoulder arthritis is already so advanced that their motion is limited, so it may be difficult for them to strengthen the shoulder before surgery. However, I think it’s important to still use your shoulder as much as possible through daily life. It keeps the motion up and can improve some of your strength.

Does a previous rotator cuff surgery impact the outcome of a shoulder replacement?

Typically for patients that have had previous rotator cuff surgery, I tend to lean more towards a reverse replacement because the rotator cuff surgery may have failed. However, that is not always the case. When we’re in the surgery, we look directly at the rotator cuff to determine if it looks healthy and see if the replacement could potentially be an anatomic replacement or would need to be a reverse replacement.