Shoulder Prosthesis: A Guide to Shoulder Replacement

If you're considering a shoulder prosthesis, you’re likely dealing with shoulder pain, stiffness, or limited movement. A shoulder prosthesis is a man-made joint used to replace a damaged shoulder.

But how does it work, what are the different types, and what can you expect during recovery? Read on to learn everything you need to know about shoulder replacement surgery and how it can transform your life.

What is a Shoulder Prosthesis

A shoulder prosthesis is an artificial joint that replaces damaged parts of your shoulder. It was done through shoulder replacement surgery, also called shoulder arthroplasty, where they replaced the damaged shoulder joint with artificial components—a metal ball and a plastic socket.

If only one part is replaced, it’s called a partial prosthesis. Replacing both is a total shoulder prosthesis.

The first procedures started in the 1950s in the United States, originally to treat severe shoulder fractures. Over time, this surgery has been used more widely, especially for arthritis and other painful shoulder conditions.

Types of Shoulder Prosthesis

Shoulder replacement systems vary in design and materials, but most include a metal ball and a plastic socket. They’re made to copy the natural shape and shoulder motion.

There are three main types—total shoulder replacement, reverse shoulder replacement, and partial shoulder replacement (also called hemiarthroplasty).

Total Shoulder Replacement

The standard total shoulder replacement surgery replaces both the ball and socket joint with artificial parts.

The metal ball is attached to the upper arm bone (humerus) and the plastic socket is fixed to the shoulder blade (scapula), restoring the joint’s normal shape and function.

These parts come in different sizes and can be attached using two methods—with bone cement or through a press-fit design that allows the bone to grow around the implant.

The socket, typically made from polyethylene, is usually cemented into the bone. However, it may not be used if the socket still has healthy cartilage, the bone is too damaged, or the rotator cuff tendons are irreparably torn.

If you have arthritis where the bones are rubbing directly and your rotator cuff tendons are still intact, total shoulder replacement surgery is often a good fit.

Reverse Total Shoulder Replacement

Reverse total shoulder replacement surgery is used when the rotator cuff is torn or not working, or a previous shoulder replacement failed.

It switches the ball and socket positions—the ball goes on the shoulder blade and the socket goes on the arm bone. This lets your deltoid muscle move the arm instead of the rotator cuff.

Reverse replacement allows more stable movement, restoring shoulder function, and better pain relief in damaged shoulders. It’s different from anatomic replacements and works even when the rotator cuff can’t be repaired.

Partial Shoulder Replacement (Hemiarthroplasty)

Partial shoulder replacement, or hemiarthroplasty, replaces only the ball at the top of your upper arm bone (humerus).

The socket (glenoid) is left intact, making this a less invasive option when the socket surface is still healthy and rotator cuff muscles are stable or only mildly damaged.

Instead of removing the entire humeral head, this procedure fits a smooth metal surface over it, preserving more of your natural bone.

Because the glenoid isn’t replaced, surgeons must carefully evaluate it first. If it shows too much wear, this option may not be suitable.

Hemiarthroplasty can offer good improvements in movement. It is often over 40 degrees across all directions and helps maintain bone for possible future surgeries.

However, there’s a risk of the socket wearing down over time, which can lead to pain and less joint function.

Still, when the conditions are right, this approach protects your joint’s structure and may make future treatments easier and more effective.

Who Needs a Shoulder Prosthesis

You may need a shoulder prosthesis if you experience:

• Severe shoulder pain that disrupts daily activities like reaching, dressing, or bathing.
• Pain that persists at rest or is severe enough to disturb your sleep.
• Loss of shoulder movement or weakness.
• Lack of improvement with treatments like medication, cortisone shots, or physical therapy.

Shoulder replacement surgery becomes necessary when wear or damage to the joint is so severe that non-surgical treatments or joint-preserving surgeries can no longer help.

Shoulder replacement is also used to treat fractures that severely damage the shoulder, though its primary purpose is to address shoulder arthritis.

Two main types of arthritis affect your shoulder:

1. Osteoarthritis (OA) – This is the result of wear and tear on the joint cartilage, typically from years of use. While OA is common in older adults, it's more likely to affect the knees, hips, or fingers. However, active individuals, like athletes may develop it in the shoulder, especially if there’s a history of injury like a torn rotator cuff or shoulder fracture.
2. Inflammatory Arthritis – This group of autoimmune diseases, including rheumatoid arthritis and ankylosing spondylitis, causes chronic inflammation in the joints. People with these conditions often benefit from shoulder replacement surgery, experiencing significant pain relief and improved function.

The decision for surgery should involve you, your family, your physician, and your orthopedic surgeon working together. Your doctor will consider factors like your age, activity level, and the extent of joint damage.

Preparing for Surgery

You’ll need a full health check-up before surgery. Imaging tests like X-rays or MRIs help the surgeon plan your procedure.

The evaluation will include:

• Medical History – Your surgeon will ask about your overall health the extent of your shoulder pain and how it affects your daily activities.
• Physical Examination – The doctor will assess your shoulder's motion, strength, and ability.
• X-rays – These help to determine the extent of damage, showing things like joint space loss, bone irregularities, spurs, and floating pieces of cartilage or bone.
• Other Tests – In some cases, your doctor may order blood tests, a CT scan, or an MRI to get a clearer picture of the bones and soft tissues in your shoulder.

Keep in mind that it’s crucial to address any underlying health issues before surgery. Any signs of infection, such as in your heart, lungs, kidneys, bladder, teeth, or gums, must be reported and evaluated.

Managing these conditions before scheduling surgery helps prevent serious complications, like infections of the prosthesis.

Once all results are reviewed, your surgeon will discuss whether shoulder replacement is the best option and may offer other treatments like medications, injections, physical therapy, or alternative surgeries.

Make sure to ask any questions, including about recovery time and if you’ll need assistance at home.

It’s a good idea to prepare your home by placing essential items on lower shelves before surgery. You'll also need assistance with daily tasks like dressing, bathing, cooking, and laundry.

If you don't have support at home or face financial challenges, a short stay in a rehabilitation facility might be necessary until you're more independent.

The Shoulder Replacement Procedure

The surgery typically takes 1 to 2 hours and is done under general anesthesia, so you'll be asleep during the procedure.

During the procedure, the surgeon replaces the damaged parts of your shoulder joint with a prosthetic device, which could be a total or partial shoulder replacement, depending on your condition.

After surgery, you’ll spend some time in the recovery room before being discharged home or transferred to a rehabilitation facility for further care. Most patients stay in the hospital for one or two nights after surgery.

Recovery After Shoulder Replacement Surgery

Immediately after surgery, your arm will be in a sling for support. You’ll start gentle movements with a therapist within a few days. Most people can return to light activities like cooking or work within 6 to 12 weeks.

You’ll be given antibiotics to prevent infection. Most patients can eat solid food and get out of bed the next day. If you’re in the hospital, you’ll likely go home the day after surgery.

Here are key areas to focus on during your recovery:

• Pain Management – Pain is normal after surgery. Medications, including opioids and NSAIDs, will help manage it. Opioids should be used minimally, as they can be addictive. Follow your doctor’s instructions to avoid complications.
• At-Home Recovery – You’ll need to wear a sling for 2 to 6 weeks and care for your wound based on the complexity of your surgery and your surgeon's recommendations. They will also provide instructions for proper wound care.
• Activity – Exercise is key to recovery. Most patients can do simple tasks like eating and dressing within 2 weeks.

Do’s and Don’ts After Surgery

The success of your surgery will depend on how well you follow your orthopedic surgeon's instructions at home during the first few weeks.

Here are some common do’s and don’ts for when you return home:

• Do follow your exercise plan and ask for help if needed.
• Don’t use your arm to push up from a chair or bed, and avoid extreme arm positions for 6 weeks.
• Don’t lift anything heavy or engage in contact sports.
• Don't soak the wound in water until it is fully sealed and dry.
• Don't drive for 2 to 6 weeks.
• Don't lift anything heavier than a glass of water.

With proper care, you’ll experience less pain, improved motion, and better function.

Rehabilitation After Shoulder Replacement Surgery

Physical therapy will begin soon after surgery to regain strength and flexibility. The first 6 weeks focus on maintaining the passive range of motion in the shoulder joint to ensure proper healing.

This is especially important for shoulder surgery, as the joint is most likely to lose motion without specific exercise.

Once the bones, tendons, muscles, and skin have healed (typically after six weeks), you can begin exercises to rebuild strength.

You can gradually return to daily activities and begin moderate sports or gentle exercises, but always under the guidance of your shoulder specialist.

You may follow a rehabilitation plan on your own or work with a physiotherapist to ensure optimal recovery. Continue exercises at home as prescribed to support your progress.

Risks and Complications

Like any surgery, shoulder replacement carries risks. Potential complications include:

• Infection – This is a common complication in any surgery. It can occur at the wound site or deep around the prosthesis, either during the hospital stay, after going home, or even years later. Minor infections can usually be treated with antibiotics, but more severe infections may require additional surgery and even removal of the prosthesis.
  
• Shoulder prosthesis issues – Although prosthesis designs and materials continue to improve, wear and tear can cause the components to loosen from the bone or even dislocate. Excessive wear or dislocation may require revision surgery.
  
• Nerve damage – Though rare, it can occur in the area around the joint replacement during surgery. These injuries often improve over time and may fully recover.
  
• Fractures – The bones (glenoid bone or humerus bone) surrounding the prosthesis can become weaker, making stress fractures a possible complication.
  
• Stiffness – An arthritic shoulder is often very tight before surgery, limiting your movement. If stiffness remains after surgery, it is typically due to incomplete rehabilitation. Ongoing physical therapy exercises are usually effective in restoring your shoulder motion and strength, helping to overcome this stiffness.
  
• Dislocation – It's possible for the ball of your new joint to come out of the socket.
  
• Rotator Cuff Failure – The rotator cuff muscles and tendons surrounding the shoulder joint can wear out after a partial or total shoulder replacement.
  

While these risks exist, it's important to be aware of them and be prepared for the possibility of additional procedures, such as revision surgery, if the initial surgery does not provide the desired results.

Conclusion

Shoulder replacement surgery is a highly effective procedure for treating severe shoulder fractures, shoulder arthritis, and rotator cuff injuries. The procedure involves replacing the damaged parts of your shoulder joint with artificial components, which can provide significant pain relief and improved shoulder function.

You should be aware of the potential risks and complications when considering shoulder replacement surgery, as well as the importance of physical therapy exercises in the recovery process.

By understanding the different types of shoulder replacement, the risks of the procedure, and the importance of rehabilitation and recovery, you can make informed decisions about the treatment and improve your overall quality of life.

Always follow the specific instructions from your surgeon for the best possible outcome, and attend follow-up appointments to monitor your progress.

Frequently Asked Questions

What can you never do after shoulder replacement?

After a shoulder replacement, it's important to avoid heavy lifting, do sports, and other strenuous activities that can strain your shoulder and hinder your recovery process.

What is the downside of a shoulder replacement?

The downside of shoulder replacement surgery includes potential complications such as infection, fracture, instability, loosening of the prosthesis, and the need for revision surgery.