Shoulder Pain Management
Frequently Asked Questions About Shoulder Replacement
Can shoulder replacement surgery relieve my patient’s pain and stiffness?
Most patients who have shoulder replacement surgery report less pain and good range-of-motion after full recovery.
Who is a candidate for shoulder replacement?
A shoulder specialist will need to determine if a patient is a good candidate for surgery. Candidacy will be dictated by the shoulder symptom etiology and severity of disease, as well as the overall health of the patient. In cases where the disease state or joint damage is progressive, early intervention may provide for better outcomes. In one study 95% of patients who had shoulder replacement reported pain relief.1
What type of shoulder replacement procedure would be performed on my patient?
A shoulder specialist will need to determine which surgery best fits your patient’s needs and goals. Depending on the shoulder symptom etiology and severity of disease, total shoulder replacement may be a better choice than other surgeries.
What are the benefits and risks of shoulder replacement surgery?
Shoulder replacement surgeries generally relieve pain and provide good range-of-motion. However, some patients may experience complications including joint failure, inadequate pain relief and the need for more surgery. In one study, 93% of shoulder replacement patients reported post-op satisfaction after 15 years.2 The study was conducted between 1985 and 1991 to determine the results, the risk factors for an unsatisfactory outcome, and the failure rates of total shoulder arthroplasty with a cemented metal-backed glenoid component. During that time period, 100 total shoulder arthroplasties with cemented metal-backed glenoid components were performed to treat osteoarthritis. The mean age (and standard deviation) of the patients was 68 ± 8 years. The study group included 61 men and 33 women. Ninety-five shoulders were followed for a minimum of two years (mean 10.8 years) or until the time of revision surgery. Patients were assessed with use of a modified Neer rating system at the time of the latest follow-up. Radiographs of eighty-three shoulders were assessed for the presence of glenoid erosion, glenohumeral subluxation, periprosthetic lucency, and a shift in component position. Total shoulder arthroplasty with a cemented metal-backed glenoid component was significantly associated with pain relief as well as with an improvement in abduction and external rotation. According to the modified Neer result-rating system, the result was excellent in forty-seven shoulders, satisfactory in twenty-seven shoulders, and unsatisfactory in twenty-one shoulders. Five patients underwent revision surgery because of component loosening (two patients), component subluxation (one patient), a fracture distal to the stem (one patient), and polyethylene wear (one patient). Glenoid periprosthetic lucency was present in sixty-nine (83%) of eighty-three shoulders at a minimum radiographic follow-up of two years. The survival rates at 5, 10 and 15 years for these implant components were estimated to be 98%, 97% and 93% respectively.2
How common is shoulder replacement surgery?
About 23,000 total shoulder replacement surgeries are performed each year in the United States.3 It is the third most common joint replacement after knee and hip replacement.3
Is shoulder replacement safe?
A 7-year study (1994-2001) showed that shoulder arthroplasty had low rates for complications, comparable to hip and knee arthroplasty.4 The study compared the inpatient mortality, complications, length of stay, and total charges of patients who had shoulder arthroplasty for osteoarthritis with those of patients who had hip and knee arthroplasties for osteoarthritis. A review of the Maryland Health Services Cost Review Commission discharge database identified 994 shoulder arthroplasties (average age 69.2 years), 15,414 hip arthroplasties (average age 66.5 years), and 34,471 knee arthroplasties (average age 68.1 years) performed for osteoarthritis. There were no in-hospital deaths after shoulder arthroplasty, whereas 27 (.18%) and 54 (.16%) deaths occurred after hip and knee arthroplasties, respectively. Compared with patients who had hip or knee arthroplasties, patients who had shoulder arthroplasties had, on average, a lower complication rate, a shorter length of stay, and fewer total charges. Patients who had shoulder arthroplasty had half as many in-hospital complications as those with hip or knee arthroplasties and were 1/6 as likely to have a length of stay 6 days or greater, and were 1/10 as likely to be charged more than $15,000.
How long does recovery and rehabilitation take after surgery and what can my patients expect?
Total shoulder replacement patients will need a caregiver for about 6 weeks after surgery because they will not be able to drive during that time. Total recovery may take as long as 6 months.
How long will my patients be off work?
Ability to return to work will depend on how physically demanding the job is and how quick the patient progresses in physical therapy. Full recovery may take up to 6 months, but many patients may be able to return to work much quicker, especially with activity modification.
How long will my patients be restricted from sports and leisure activities?
Patients should be able to perform activities of daily living at about 6 weeks after surgery. However, a return to sports and leisure activities will depend on their progress in physical therapy. Your patient should seek advice from the health care team prior to performing any activity that places a moderate to heavy load on the shoulders.
How much physical therapy is needed after shoulder replacement surgery?
Physical therapy may begin the day after surgery. In the first 6 weeks after surgery, the patient should expect to see the physical therapist two to three times a week. The patient may be involved in a progressive rehabilitation program for 2 to 4 months after surgery to ensure the best results from the artificial joint.
What activities can my surgical patients participate in after recovery?
Many patients can expect to perform the activities after surgery that they performed before surgery. Exceptions include activities that place heavy loads on the artificial shoulder.
Can people live with shoulder pain or will my patients harm themselves further if they don't seek treatment?
Shoulder pain is often the sign of a condition that will worsen with time, such as glenohumeral arthritis. In some cases, early surgery may provide the best outcome. Therefore, it is best to have the shoulder examined by an orthopaedic shoulder specialist as early as possible when presented with the condition.
Are there other alternatives to shoulder replacement surgery?
For mild shoulder conditions, physical therapy may provide symptomatic relief. However, some patients may require steroid injections for the short-term control of inflammation. Steriods injections are limited to four per year in most cases and they may provide short-term relief, but they will not prevent ongoing joint degradation. Minimally invasive arthroscopy may be a good choice for patients with rotator cuff tears or who require the removal of bone spurs. For progressively degenerative conditions such as arthritis, shoulder replacement may be the best choice for relief.
- “Shoulder Replacement No More Risky than the Replacement of Other Joints.” ScienceDaily. March 27, 2007. Available at: http://www.sciencedaily.com/releases/2007/03/070326152529.htm.
- Tammachote N, Sperling JW, Vathana T, Cofield RH, Harmsen WS, Schleck CD. “Long-Term Results of Cemented Metal-Backed Glenoid Components for Osteoarthritis of the Shoulder.” J Bone Joint Surg Am. Jan 2009;91(1):160-166.
- Millennium Research Group. U.S. Markets for Small-Joint Devices 2008.
- Farmer KW, Hammond JW, Queale WS, Keyurapan E, McFarland EG. “Shoulder Arthroplasty Versus Hip and Knee Arthroplasties: A Comparison of Outcomes.” Clin Orthop Relat Res. Feb 2007;455:183-189.