The Patient’s Guide to Shoulder Replacement

by David Novak, M.D.

The Patient’s Guide to Shoulder Replacement

Many people experience shoulder pain in their lifetime. People can strain their shoulder, or their rotator cuff can become inflamed, but these symptoms can be treated by non-surgical methods. Trauma and arthritis are the main reasons why patients need shoulder replacement surgery. If the pain or injury is significant enough, like ongoing dull pain or loss of movement, see a doctor for a diagnosis.  

Shoulder Replacement Surgery 

There are two main types of shoulder replacement: anatomic and reverse. An anatomic replacement keeps the socket part of the joint on your shoulder and the ball part of the joint on your arm, the way your arm naturally is. If you have arthritis in your shoulder to the point of severe joint pain, that is usually an indication that you need an anatomic or primary replacement. This kind of replacement requires the rotator cuff to be intact and usable. 

Reverse replacement is used when the rotator cuff is significantly torn or there is a fracture in the shoulder. In a reverse replacement, the ball and socket joints switch sides, reversing their positioning. This kind of replacement has replaced the traditional use of plates and screws and has been more successful because often the bone does not hold hardware well. For patients who have low bone density due to age, reverse shoulder surgery is an option because it no longer requires plates or screws.  

Before surgery, a CT scan will allow the doctors to create a model of the shoulder’s anatomy and properly map out the entire procedure. The use of CT scans and mapping ensures that the surgery is efficient and minimally invasive. A vast majority of shoulder replacements are done as outpatient procedures which allow the patient to recover at home to decrease the risk of infection.  

Shoulder Replacement Recovery 

Recovery looks different for every patient, but the one common complaint afterward is the difficulty sleeping. Shoulder surgery is done through small scope incisions which can be uncomfortable to lay flat on during recovery. For a few weeks post-op, it is important to sleep at a 45-degree angle using a recliner or wedge pillow. This alleviates the discomfort and allows patients to sleep without pain. 

Reverse shoulder replacement surgery has a different recovery process than anatomic shoulder replacement because it is focused more on the rotator cuff. After reverse shoulder replacement surgery, a sling is used to keep the shoulder stable for a month. The sling prevents the shoulder from moving, allowing the bone, joints, and tendons to heal in the correct position as well as decreasing the risk of dislocation. A week after the surgery, physical therapy begins, starting with the PT passively moving the arm so it will not get stiff. After a month, the sling goes away, and the patient can begin moving their arm on their own. In the third month, strengthening exercises are introduced in physical therapy to get the shoulder to build some strength back. Physical therapy will last for 8-12 weeks to improve mobility and strengthen the shoulder.  

Anatomic shoulder replacement involves an intact rotator cuff, so the focus in the first month after surgery is not to move the shoulder past a certain degree to ensure it stays intact. Everything from that point on is similar to the reverse replacements where there are six to eight weeks for tendon healing and then the focus shifts to strengthening the part of the cuff that was affected by the replacement. For both types of shoulder replacement, recovery can take up to a year or so before full mobility or strength is restored.

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