What Is Shoulder Replacement Surgery? - Types & Procedure Everything Explained

Shoulder replacement surgery is performed under the guidance of an expert orthopaedic surgeon. It is carried to relieve the pain and symptoms that patients suffer due to damage of the shoulder joint.

This piece throws light on all the crucial aspects of this surgical procedure to heighten awareness among people seeking necessary treatment.

Shoulder replacement is a procedure to eliminate any dysfunctional issue or dislocation resulting in severe pain. In this surgery, the doctor replaces the damaged area of the shoulder joints with artificial elements. These elements are prostheses and the types differ according to the surgery done.

The primary purpose of undergoing any type of shoulder replacement procedure is to obtain optimum pain relief. In addition, this procedure helps restore the shoulder's strength and functions.

The after-effect of this surgery enables patients to perform all activities smoothly, which they were avoiding due to chronic shoulder pain. Other conditions this surgery can treat includes:

• Loss of motion in the shoulder
• Weakness in the shoulder
• Disturbed sleep due to pain

1. Traditional Shoulder Arthroplasty (Total Shoulder Replacement)

In this surgical procedure, a surgeon replaces the original ball-and-socket area of the shoulder with exact-shaped prosthetics. This shoulder replacement surgery is mostly performed when the patient suffers from paralysing shoulder arthritis. 

However, one must avoid such procedures who like to stay very active or engage themselves in sports or athletic activities. In addition, people with damaged rotator cuff muscles must take multiple consultations before total shoulder replacement.  

• Benefits
  • Beneficial for those who have healthy rotator cuff
• Survival Rate After Surgery
  • 10 Years: 97%
• Cost of Surgery: ₹5 lakhs approximately

2. Reverse Total Shoulder Arthroplasty (Reverse Shoulder Replacement)

This type of shoulder replacement treatment involves completely replacing or reversing the shoulder joint's ball-and-socket position. This means a prosthetic ball is used to fit a natural socket of that shoulder, whereas, a ball on an upper arm bone, called the humerus, goes through a replacement procedure with a socket-shaped prosthetic. 

For patients suffering from damaged rotator cuffs or who are incapable of traditional shoulder replacement surgery, reverse total shoulder arthroplasty is the ultimate option. This surgical treatment offers relief by allowing muscles to function normally even without a rotator cuff.

• Benefits
  • Faster recovery than traditional shoulder replacement
  • It helps in strengthening and stabilising muscles
  • It serves as an option for those that did not benefit from traditional shoulder replacement
• Survival Rate After Surgery
  • 5 Years: 71.6%
• Cost of Surgery: ₹3.25 lakhs approximately

3. Stemmed Hemiarthroplasty (Partial Shoulder Replacement)

A stemmed hemiarthroplasty is a procedure where a doctor removes the entire top part of the arm humerus. The completion of this first step involves the replacement with a prosthetic ball, and a glenoid bone is kept. 

However, a surgeon may reshape this part of the socket to ensure better shoulder joint movement. This process is informally known as “ream and run”. 

• Benefits
  • Increases range of motion
  • Decreases swelling and stiffness
  • Reduces pain
• Survival Rate After Surgery
  • 10 Years: 97%
• Cost of Surgery: ₹3.7 lakhs approximately

4. Resurfacing Hemiarthroplasty (Shoulder Resurfacing)

In this type of shoulder resurfacing, a smooth rounded cap is placed on a humeral head to ensure better movement.

However, this surgery does not require the total removal of the top of the humeral head or the insertion of a prosthetic stem.

• Benefits
  • Less procedural time
  • Preserves bone stock in active and young patients
  • Decreased incidence of humeral periprosthetic fractures
• Survival Rate After Surgery
  • 10 Years: 89%
• Cost of Surgery: ₹4 lakh approximately

To prepare the body for surgery, doctors will give you a nerve block (interscalene block) before the surgery. It will numb the shoulder and arm for easy operation. However, even after this, you will receive general anaesthesia during the procedure. Other preparations you can make are as under:

• Doctors may ask you not to eat or drink anything past midnight before the day your surgery is scheduled.
• Wear something loose and cotton-made. Also, prefer a buttoned shirt as it will be easy to wear when your arms are still numb.
• During your prior appointments, discuss the list of medications you are taking. If you require any changes or skipping of medications, your doctor will inform you accordingly.
• Arrange for a cab or support from before who will take you safely from the hospital to home.

Although a successful shoulder replacement surgery will not let any serious complications emerge, there are a few risk factors involved in the procedure. They are:

• Infection: This mostly includes minor infections in an area where the surgery has been performed. However, the treatment of this kind of infection requires the right dosage of antibiotics. Though in severity, additional surgery can take place for healing purposes.
• Loosening of Glenoid: Located in the lateral scapula, the glenoid is the socket portion of the shoulder joint. If the etiology of the glenoid component starts loosening, individuals face problems like rotator cuff insufficiency, osteolysis, soft tissue instability, etc. This can happen after a successful SRS.
• Instability or dislocation: In the case of reverse total shoulder replacement, patients may suffer from dislocation of prosthetics implants from that spot. In this case, it requires additional surgical procedures like reduction to fix the implants.
• Damage of nerve: Even after a successful SRS, there are possibilities of nerve damage. Cases reveal that this surgery can damage the axillary, musculocutaneous, radial, suprascapular, and subscapular nerves.
• Shoulder stiffness: One of the most common consequences of this surgery is shoulder stiffness. It happens to almost every patient undergoing this surgery. It is usually harmless but can be painful and uncomfortable. After about a year of the surgery, the problem starts fading away.

Patients undergoing this surgical treatment must consider stiffness in an affected area of the shoulder before the surgery. However, stiffness post-surgery can result from incomplete rehabilitation or lack of rest.

Hence, it is always advisable to get the necessary medical attention and physical therapy as per the prescription to restore motion and regain the strength of the shoulder.

Moreover, these shoulder replacement surgery risk factors can be remarkably intense if a patient already suffers from diabetes. In this situation, healing from such a surgical procedure takes a good amount of time.

Before the surgery, you will be in the preoperative area, where a nurse will monitor your vital signs, blood sugar level and pregnancy status (if applicable). Further, you will have to change into hospital clothes, remove any jewellery you are wearing and rest on the surgical table for the procedure.

The surgical gown will give the surgeon easy access to the shoulder, where he will perform a nerve block procedure. Then you will have to wait until they take you to the operating room.

The shoulder replacement treatment procedure depends on the surgery the patient is undergoing. The traditional shoulder arthroplasty generally involves replacing the affected joint ball (humeral head) and joint socket (glenoid cavity) with a metal ball and a fine plastic cup.

This metal-on-plastic implantation is applied virtually in all types of shoulder replacement surgery.

A total shoulder replacement procedure requires regional anaesthesia or general anaesthesia depending upon the condition of an affected area. The operation process involves a patient, positioned sitting upright, to be completely or partially sedated.

Here are the steps explaining the procedure of shoulder replacement surgery for better understanding. These are:

Step 1: In this initial step, a performing surgeon will disassociate the deltoid and pectoral muscle to get a clear view of the affected shoulder. This is for the prevention of any further nerve damage.

Step 2: Surgeons cut open the front muscle of the rotator cuff, which covers the shoulder area. This allows them to view and operate on the affected arthritic area of the ball and socket.

Step 3: This section of the joint undergoes the actual removal.

Step 4: Doctors perform careful insertion of the placement of the implant in the position of the ball, stem and socket elements.

Step 5: In this step, an orthopaedic surgeon closes and stitches the area with precision.

Step 6: The final step includes cleaning and stitching the entire external skin area and applying a temporary bandage cover.

Before proceeding with this entire surgical treatment, a specialist doctor will get multiple X-ray reports which will act as a guiding tool for fixing the affected part.

Again, some patients suffering from chronic shoulder fractures on the upper arm bone may be recommended partial shoulder replacement by specialists. This partial shoulder replacement is Hemi replacement, where only a ball material undergoes replacement.

In most cases, the recovery timeline takes around eight weeks for patients after the shoulder replacement surgery. However, it might take some time for these patients to perform any heavy-loaded work, weight or strength exercise. It is important to note that any unprescribed movements can lead to serious damage and prolonged pain.

To prevent this, a doctor runs multiple checks during the early rehabilitation period to confirm the implant's stability. Moreover, a sling's shoulder is fixed with a sling's help during this stage. However, this removal of a sling takes careful consideration under medical guidance for showering and physiotherapy, if necessary.

In most cases, patients are completely free of any pain within three to six months. This is achievable by following medical guidance, routine check-ups, and proper exercise.

If you are experiencing any issues or side effects, you can contact your doctor for questions and concerns. The symptoms that indicate threat are:

• Continuous fever
• Redness
• Swelling
• Increased drainage
• A sudden increase in pain
• Reduced movement of the arm
• Change in sensation

While surgery is the best option to cure conditions, you can also follow a few conservative alternatives available:

• Physical Therapy: Since shoulder issues are mainly related to movement restriction and not weight-bearing issues, you can opt for physiotherapy as your treatment option. Physiotherapists suggest exercises that strengthen the muscle and establish a correct balance between the shoulder blade and ball-socket joint.
• Pain Relief Medications: This is an option you can follow in mild conditions. While your body is healing, take pain medications to make your life comfortable. You can consult a pain-relief team for this treatment. Depending on your condition, they will refer you to take over-the-counter drugs like ibuprofen and paracetamol or codeine products like Co-codamol.
• Injections: Injections have also been seen to control shoulder pain. Two major forms in which the doctors recommend injections are hyaluronic acid and corticosteroids. These, as a result, reduce swelling, target inflammation, and control pain.
• Support: Slings and braces serve as support to heal shoulder injuries. This is because mobility is a great factor while recovering from shoulder injuries. In addition, when you are able to avoid stiffening and provide protection, the area heals better.

Shoulder replacement surgery is extremely successful in combating shoulder pain or fractures. However, it is pivotal to seek multiple doctors' opinions to get the best advice involving treatment.