Good candidates for shoulder surgery find it hard to lift their arm over their head and experience severe shoulder pain. They also haven't found success with non-surgical treatments like medications, rest and physical therapy. If you're thinking about surgery, come see Board-Certified Orthopedic Surgeon Dr. Mufaddal Gombera. At our office at Fondren Orthopedic Group in Houston, we'll discuss your options and provide you with advice specific to your needs and condition.
Numerous types of shoulder surgeries are available. Three of the most common are total shoulder joint replacement surgery, partial shoulder replacement surgery and reverse shoulder replacement.
- Total shoulder replacement surgery: Your orthopedic shoulder surgeon replaces the ball at the end of your long upper arm bone (humerus) with a rounded, smooth metal implant. With total shoulder joint replacement surgery, your surgeon also removes the damaged cartilage and replaces the socket with a plastic prosthetic.
- Partial shoulder replacement surgery: Here, your surgeon leaves the socket of your shoulder joint intact, and replaces the upper bone in your arm with a metal prosthetic implant. Physicians also refer to partial shoulder replacement surgery as shoulder hemiarthroplasty.
- Reverse shoulder replacement surgery: With this surgery, your shoulder doctor reverses the shoulder's normal structure. In reverse shoulder replacement surgery, Dr. Gomebera attaches the round metal implant to the shoulder blade (scapula) where the socket usually is, and then attach the artificial socket to the top of your humerus, where the ball usually is. This arrangement allows the deltoid muscles in your shoulder, which are typically fairly strong, to take on the work of moving your shoulder, which increases the joint stability.
Reverse Shoulder Replacement Surgery vs. Shoulder Replacement Surgery
When deciding on shoulder replacement, and whether you should have a total, partial or reverse shoulder replacement, a significant factor is how damaged your rotator cuff is.
For surgery to be a success, your rotator cuff needs to be in good condition for total or standard shoulder replacement surgery. You'll experience a better outcome when there's less damage to your rotator cuff.
If you have substantial damage because of a tear from an injury or severe arthritis, you might not be a good candidate for a total shoulder replacement surgery, but rather could be a more suitable candidate for reverse shoulder replacement surgery where your success falls on your deltoid muscles instead of your rotator cuff muscles. When you have persistent, severe shoulder osteoarthritis involving only the ball of the joint or humeral head, you might be a candidate for partial shoulder replacement. Here we will take a look at more information about reverse shoulder replacement surgery and shoulder replacement surgery.
How Do I Know When I'm Ready for a Shoulder Replacement Surgery?
If you have pain in your shoulder, limited function and difficulty sleeping, consider getting cortisone injections or taking arthritis medications. If you find the injections and medications don’t provide relief for your shoulder pain, then it is time to discuss a shoulder replacement, and whether it should be a partial or total shoulder replacement.
How Do I Know When I'm Ready for a Reverse Shoulder Replacement Surgery?
We may recommend a reverse shoulder replacement surgery if you have:
- Cuff tear arthropathy
- A totally torn rotator cuff that we can't repair
- A complex shoulder joint fracture
- A previous unsuccessful shoulder replacement
- A chronic shoulder dislocation
- Difficulty lifting your arm over your head or away from your side and severe shoulder pain
- A tumor of your shoulder joint
- Have tried other methods of treatment like medications, rest, physical therapy or cortisone injections that haven't relieved the pain in your shoulder
When Will I Start Experiencing Shoulder Pain Relief After My Shoulder Surgery?
There’s some immediate change to your shoulder movement regarding being much smoother, but, for several weeks following your surgery, it’s more painful than before. At approximately two weeks after surgery, individuals begin getting over the “hump,” and it’s less painful than what it was before the procedure. Your pain should continue slowly decreasing. Most individuals are happy they had a shoulder replacement around a couple of months post-op.
Will I Have to Stay in the Hospital After My Shoulder Replacement Surgery?
Yes. The typical stay is somewhere between 24 and 48 hours — 50 percent stay one day, while 50 percent stay two days. Rarely do patients stay longer than two days.
What's the Hospital Stay Time After My Reverse Shoulder Replacement Surgery?
Reverse shoulder replacement surgery typically takes around a couple of hours, but the preparation for the surgery and the postoperative recovery might add a few more hours on to this time. You could spend a couple of hours in the recovery room, and anywhere from two to five days after surgery in the hospital.
What Is the Shoulder Replacement Surgery Recovery Time?
Here is the total shoulder replacement protocol and what to expect after your shoulder replacement.
After your hospital stay, your recovery will involve the following.
1. Pain Management
Your shoulder will hurt and swell. We can prescribe you medication to help manage your pain. You can control the swelling with cold compresses.
We'll put your arm in a brace at first to keep it from moving. After about a day or two, you may start physical therapy to help your new shoulder start working.
After you go home, you'll continue physical therapy. You'll perform certain exercises that will slowly improve the function of your new joint. Make sure you don't rush things. It could take up to four weeks before you're able to pick up objects heavier than a glass of water. However, limitations after shoulder replacement surgery are minimal.
For the majority of your recovery, your arm will be inside a sling. It could be six weeks or more before you can get behind the wheel of a car again.
You'll have a few follow-up visits with your doctor during the year following your surgery so we can see how well your recovery is going.
What Is the Reverse Shoulder Replacement Surgery Recovery Time?
After your surgery, we'll provide you with a few doses of antibiotics to minimize your risk of infection. Most individuals can get out of bed and eat solid food the day after their procedure. You'll likely go home after the second or third day following your surgery.
After your hospital stay, your recovery will involve:
1. Pain Management
You'll feel some pain after the procedure. This is normal, and part of the healing process. We'll work to minimize your pain, which can help with a faster recovery.
To help you with short-term pain relief, we'll prescribe you medications. There are numerous types of medications to help manage your pain, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and local anesthetics. We might use a combination of these to offer you relief and help reduce your need for opioids.
While opioids can help with pain relief after surgery, they can become addictive because they're a narcotic. Opioid addiction and overdose have become a pressing public health concern. It's essential you only use opioids as your surgeon directs. Once you begin noticing an improvement in your pain, stop taking the opioids. Let us know if your pain hasn't started to improve within several weeks of your procedure.
We will place your arm inside a sling before you leave the hospital. We'll give you several gentle range of motion exercises you can perform to help increase your endurance and mobility. Physical therapy will likely be part of your recovery regimen as well to help strengthen and improve the flexibility of your shoulder.
You should be able to dress and groom yourself and eat within several weeks following your procedure. We may have you come back to our office for a follow-up and maybe some x-rays to monitor your shoulder.
How Long Will My Shoulder Replacement Last?
Your shoulder replacement should last between 15 to 20 years. However, this is a variable estimate, and some individuals’ replacements last even longer. It’s hard to predict precisely how long your shoulder replacement will last, particularly because there’s been a significant improvement to the materials we use than those used seven to eight years ago.
Generally, if you require a shoulder replacement, you don’t redo only parts, but rather the entire thing. But we would rarely need to do that. Most individuals’ initial shoulder replacement should last for as long as they require them.
How Long Will My Reverse Shoulder Replacement Last?
The reverse prosthesis is excellent at relieving pain. European studies show that around 90 percent of patients who have this surgery experience great pain relief. How much pain relief you experience will depend greatly on why we perform the surgery. For instance, for revision cases, the degree of pain relief is a little lower than for operations performed for the first time, likely because of the long term damage and scar formation.
The reverse prosthesis should also help restore some of your shoulder's range of motion, but the degree of return isn't as predictable as relief of pain. Most individuals can reach over their heads without having to tilt their head. Most individuals see enhanced motion in other directions. However, if they have a completely torn rotator cuff, they might not see any improvement in their ability to reach out in an external rotation — that is, out to the side away from their body.
As with the conventional shoulder replacement, the reverse prosthesis should last at least 15 years.
What Are the Shoulder Replacement Pros and Cons?
As a potential candidate for shoulder replacement, it’s essential to weigh both the advantages and disadvantages of surgery.
1. Pros of Shoulder Replacement
First of all, the purpose behind the shoulder joint replacement surgery is to restore mobility and relieve chronic pain so you can go back to normal living. Also, your doctor may suggest a shoulder replacement as a treatment for:
- Rheumatoid arthritis
- Bone tumor
- Post-traumatic arthritis
- Severe fractures
- Avascular necrosis
- Rotator cuff tear arthropathy
Recently, there have been prosthetic design advancements which allow individuals to get back to their active lifestyles after surgery. They can often go back to golf, swimming, baseball or numerous other activities they enjoy.
2. Cons of Shoulder Replacement
Some potential complications with shoulder replacement surgery are:
- Infection: Infection can occur with any surgery. However, with shoulder joint replacement, it could occur deep around the prosthesis or in the wound. It can occur while you're in the hospital or once you're home. It can even occur several years later.
- Prosthesis problems: While prosthesis materials, designs and surgical techniques continue advancing, the prosthesis could wear down, and the pieces could become loose. The shoulder replacement components might also dislocate. Excessive loosening, wear or dislocation could require revision surgery.
- Nerve injury: During surgery, the nerves near the joint replacement could become damaged, although this is a rare type of injury. As time passes, these nerve injuries typically improve and might totally recover.
What Are the Pros and Cons With Reverse Shoulder Replacement?
If you’re considering reverse shoulder replacement surgery, weigh both the pros and cons.
1. Pros of Reverse Shoulder Replacement Surgery
Your shoulder joint is also known as a "ball and socket" joint since it's formed by connecting the "ball" with the "socket." The "ball" is a dome-shaped head of your humerus bone of your upper arm. The "socket" is your shoulder's glenoid cavity. When a fall or accident causes your rotator cuff to tear or compounds the damage existing joint arthritis causes, your shoulder can become very unstable.
Reversing the shoulder's natural anatomy stabilizes the joint. Reversing the "ball and socket" position during the reverse shoulder replacement procedure compensates for the loss of your rotator cuff and your shoulder's deltoid muscle can raise the arm once again.
Another pro is we can perform this procedure for anyone who had a previous ineffective shoulder replacement. It might also help individuals with things like:
- Chronic shoulder dislocation
- Complex shoulder joint fractures
- Shoulder joint tumor
Those looking to have reverse shoulder replacement surgery have typically run out of other options of restoring function to their damaged shoulder. The biggest pro of this procedure, then, is to basically give them back a normal pain-free life.
2. Cons of Shoulder Replacement
Like with any procedure, the reverse shoulder replacement procedure also comes with certain risks. Some possible complications could include:
- Blood vessel or nerve damage
- Shoulder dislocation
- Loosening of the artificial joint
Performing this surgery is a demanding surgery which only an experienced surgeon should perform. Although there are several cons with this procedure, there are many pros that outweigh any of the drawbacks for carefully selected individuals.
How Much Does Shoulder Replacement Surgery Cost?
Whether you're looking for the shoulder replacement surgery cost or the cost for reverse shoulder replacement, the same rules apply — check with your insurance.
Because insurance coverage is a complex business that doesn’t have any fixed rules, be sure you contact your insurance provider regarding your proposed shoulder surgery specifics. Keep in mind that the hospital bill isn’t something we have control over, so you’ll need to direct your questions concerning hospital, anesthesia, laboratory and x-ray specifics to the billing office of the hospital.
What Other Options Are Available?
While surgery may be the best option for you, other treatments are available. You can try medication, injections and physical therapy exercises. You can also have no treatment and just live with the condition. Perhaps you will have success with some of these options. Perhaps you have already tried others. However, if these treatments haven't been successful in the past, they aren't likely to work reliably in the future. Of course, we can attempt any or all of these other treatments if you wish.
Contact Dr. Gombera to Schedule Your Shoulder Replacement Surgery Consultation
Dr. Gombera is Houston's go-to shoulder replacement surgery specialist. He is board-certified and specializes in arthroscopy, sports medicine and treatment of knee, shoulder and hip injuries. He stays up-to-date with all the latest, innovative and minimally invasive techniques. Contact our office to schedule your consultation with Dr. Gombera for your shoulder replacement surgery.