Shoulder Replacement

Candidates for shoulder replacement typically include individuals with severe shoulder pain that interferes with everyday activities and hasn’t improved with non-surgical treatments, such as physical therapy or medications. Conditions that may lead to the need for shoulder replacement include:

• Osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis
• Rotator cuff tear arthropathy
• Avascular necrosis (osteonecrosis)

Anatomic TSA is usually recommended for patients with intact rotator cuffs and primary osteoarthritis. In contrast, Reverse TSA is often used for individuals with a complex combination of shoulder conditions, including severe rotator cuff tears and certain types of severe fractures.

Before your procedure, your shoulder surgeon Dr. Mayo uses advanced imaging with CT scans to create three-dimensional models of the bones in your shoulder. This allows him to create a personalized surgical plan for your anatomy. Dr. Mayo will evaluate multiple factors such as the amount of bone remaining in your glenoid, how much tilt or version it has, and the size of your humerus and glenoid. This will allow him to create a precise surgical plan to best restore your anatomy and function with the best sized and positioned implants for you.

Once the procedure is planned, both Anatomic and Reverse TSA are performed under general anesthesia, meaning you’ll be asleep during the surgery. Your shoulder surgeon Dr. Mayo will make an incision over the front of the shoulder to expose the shoulder joint. In Anatomic TSA the damaged parts of the shoulder joint are removed and replaced with prosthetic components. In Reverse TSA, the ball component is attached to the shoulder blade and the socket component to the arm bone.

Recovery from shoulder replacement surgery varies depending on the individual and the specific surgery type, but full recovery typically takes several months. Patients can often return to desk work or light activities within a few weeks. However, a return to heavy lifting or sports activities could take four to six months or longer.

Immediately after surgery, you’ll likely be in a recovery room where your vital signs are monitored as you recover from anesthesia until you are able to go home that day. Your arm will be immobilized in a sling. Pain medications will be provided to manage any post-operative discomfort.

Physical therapy plays a crucial role in recovery following shoulder replacement. The therapy program typically involves:

• Early Stage (Weeks 1-6): Initial exercises aim to restore a range of motion in the shoulder. You’ll probably continue wearing the sling during this stage.
• Middle Stage (Weeks 6-12): As healing progresses, you’ll start active range-of-motion exercises and gentle strengthening exercises.
• Late Stage (3 months and beyond): This phase involves more advanced strengthening exercises and activities aimed at returning to normal function.

As with any surgery, shoulder replacement carries some risks:

• Infection: Although uncommon (around 1-2% of cases), infections can occur after surgery. Antibiotics are given before surgery to minimize this risk.
• Instability or dislocation: The replacement joint may become unstable or even dislocate in rare cases (less than 1% for anatomic TSA and around 4% for reverse TSA).
• Component loosening or wear: Over time, the artificial joint components can wear out or loosen. This happens in approximately 5% of patients at 10 years for anatomic TSA.
• Nerve damage: While rare, nerves around the shoulder can be injured during the procedure.
• Blood clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) can occur but are rare.

If your shoulder surgeon Dr. Ben Mayo recommends shoulder replacement and you choose not to undergo surgery, there are potential risks:

• Persistent pain: Your shoulder pain may continue or worsen over time without surgical intervention.
• Decreased mobility: Limited shoulder function can affect your ability to perform daily activities, impacting your quality of life.
• Joint degeneration: Over time, the arthritis or other conditions causing your shoulder pain may worsen, leading to further joint damage and potentially making future treatment more difficult.