Shoulder Replacement Frequently Asked Questions

The shoulder is the most mobile joint in the human body with a complex arrangement of bone and
soft tissue (ligaments, tendons, and muscles) that work together to produce shoulder movement.
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Glenohumeral (shoulder) joint arthritis is caused by the destruction of the cartilage layer covering the
bones in the glenohumeral joint. This creates a bone-on-bone environment, which encourages the
body to produce osteophytes (bone spurs). Click here for more information.

The labrum is a disk of cartilage on the glenoid, or “socket” side of the shoulder joint. The labrum
helps stabilize the joint and acts as a “bumper” to limit excessive motion of the humerus, the “ball”
side of the shoulder joint. Click here for more information.

The major symptoms of shoulder arthritis are pain from bone-on-bone rubbing within the joint and
loss of motion. Other symptoms include atrophy, swelling, crepitus, and tenderness. Click here for
more information.

A diagnosis of glenohumeral arthritis is made after a physician will take the patient’s history from the
past several years and perform a physical examination. IX-rays of the shoulder can confirm a
diagnosis. Other imaging techniques include a CT-Scan, Arthrogram, and MRI. Click here for more
information.

Shoulder arthritis can often be managed with rest, non-steroid anti-inflammatory medications, and
exercises to increase range of motion and strength. In some cases corticosteroid injections,
glucosamine and chondroitin supplements, and viscosupplementation therapy are helpful. Click here
for more information.

Operative procedures to treat glenohumeral arthritis include debridement and shoulder arthroplasty
(replacement). Click here for more information.

In debridement, the physician smoothes the damaged articular cartilage to ease the pain and
symptoms associated with the mechanical effects of arthritis (locking, catching, and popping).
Debridement may provide temporary pain relief, but does not stop cartilage destruction, which is the
primary cause of arthritis pain. Click here for more information.

A total shoulder arthroplasty (replacement) involves the replacement of both sides of the
glenohumeral joint (the humerus and the glenoid). A hemiarthroplasty replaces the humeral head
only, and is the treatment of choice when replacement of the glenoid is not advised. The surgeon will
recommend a procedure based upon the nature and degree of the patient’s arthritis. Click here for
more information.

Even with the closest attention to detail, surgical complications may occur. Debridement surgery is
typically less complex than arthroplasty. However, as with arthroplasty, the potential complications
of bleeding, nerve injury, and infection are present. Other common complications include: infection,
blood loss, nerve injury, and component failure. Click here for more information.

During the first six to eight weeks the shoulder is immobilized with a sling. During this this time
physical therapy will begin and continue until a return to full activity is obtained, usually within four to
six months. Click here for more information.

Shoulder arthroplasty is a complex procedure, which requires a great amount of cutting of deep
tissues and bone. The surgeon takes great care to eliminate pain with appropriate analgesia both
immediately after surgery and during the rehabilitation process. A long acting local anesthetic infused
around the nerves of the joint is often used with general anesthesia during surgery. These regional
blocks will provide several hours of pain relief even after a patient has emerged from general
anesthesia. A patient-controlled intravenous infusion pump (PCA) is used in the early postoperative
period for pain control. By the second or third day after surgery, oral pain relief medication
is adequate through the early rehabilitation period (4-6 weeks). Click here for more information.

The time it takes to return to normal activity varies greatly from patient to patient. Most individuals
have less pain at night or at rest in the first 2-4 weeks after surgery. Pain with activity persists longer,
but generally decreases as the strength and function of the shoulder muscles improve. Full recovery
usually takes 4-6 months. Click here for more information.

The goal of shoulder arthroplasty is to relieve the pain from glenohumeral arthritis. It is unrealistic to
expect to return to repetitive, heavy, overhead activities, which would put the replacement
components at risk. Shoulder function after arthroplasty is also unlikely to allow the motions required
by these activities.
According to the American Shoulder and Elbow Society, the acceptable activities after a shoulder
arthroplasty are: bowling, doubles tennis, cross-country skiing, swimming, canoeing, and shuffleboard
and for those with previous experience in the activity: golf, ice skating, shooting, and downhill skiing.
Unacceptable activities are: football, gymnastics, hockey, rock climbing, throwing sports, except for
gentle underhand tossing. Click here for more information.

Long-term studies show that 85-90% of total shoulder replacements are functioning well ten years
after implantation, and 75-85% are doing well fifteen years after surgery. Over time, current advances
in materials and techniques should improve these percentages even more. Click here for more
information.