Total shoulder replacement is a surgical procedure generally performed in cases of advanced shoulder osteoarthritis. Degenerative in nature, shoulder osteoarthritis (omarthrosis) causes stiffness in the shoulder joint, which worsens over time. A total shoulder replacement allows the patient to regain both the natural mobility of the shoulder and relief from pain. Depending on the type of osteoarthritis, two types of prostheses may be considered. This choice is made following a thorough assessment of the osteoarthritic condition by the surgeon. In some cases of necrosis or shoulder fracture, a total shoulder replacement may also be indicated. If you are affected by any of these three conditions, this article will help you understand the surgical procedures involved, the rehabilitation phase, the expected results, and possible complications.
What Is a Total Shoulder Replacement?
A shoulder prosthesis is a medical device surgically implanted to replace a damaged joint. The primary goal of this surgery is to restore shoulder mobility and reduce chronic pain, thus enabling patients to regain a better quality of life.
When Is Total Shoulder Replacement Recommended?
This procedure is indicated in several cases, especially for advanced osteoarthritis and certain complex fractures. Osteoarthritis involves localized wear and tear and can be accelerated by various factors that must be considered during the preoperative consultation. A rheumatic disease (such as chondrocalcinosis or rheumatoid arthritis), recurrent shoulder dislocations, a fracture in the joint area, or a torn rotator cuff can be aggravating factors that should not be underestimated. All these symptoms must be treated medically before surgery. This treatment may include painkillers, hyaluronic acid injections, or physical therapy.
The Two Types of Omarthrosis: Centered or Eccentric
Shoulder osteoarthritis can present in two different forms depending on the patient.
- Centered omarthrosis: This occurs when the rotator cuff is intact, allowing the humeral head to remain well-centered in the glenoid of the scapula. In such cases, the osteoarthritis has developed only on the humeral head (bone of the upper arm) and the glenoid cavity of the scapula (shoulder joint).
- Eccentric omarthrosis: This develops in the case of a massive rotator cuff tear, causing the humeral head to shift upwards and resulting in joint misalignment, which may require a reverse shoulder prosthesis.
What Are the Different Types of Shoulder Prostheses?
The choice of prosthesis depends on several factors, including the condition of the rotator cuff, the patient’s age, activity level, and functional expectations. Based on diagnostic analysis, the surgeon will choose one of two prosthesis types. Through X-rays and physical examinations, the surgical procedure will be determined and explained to the patient.
Anatomic prosthesis:
This replicates the natural structure of the shoulder and is indicated when the rotator cuff is intact. This type of prosthesis restores normal shoulder biomechanics and offers very good results in terms of mobility and function.
Reverse prosthesis:
Used when the rotator cuff is deficient, this modifies the biomechanics of the shoulder by transferring muscle function to the deltoid (the outer shoulder muscle forming the shoulder cap). This approach allows patients to regain functional mobility despite the loss of rotator cuff muscles.
The Surgical Procedure for Shoulder Replacement
After a surgical consultation and a meeting with the anesthesiologist, the shoulder prosthesis can be implanted. The patient will need to stay in the hospital for about 4 to 5 days so the surgeon can monitor the healing of the scar, manage initial pain, and begin physical therapy. The surgery lasts between 60 and 90 minutes and is performed under general anesthesia.
It is crucial to stop smoking at least one month before the procedure. Nicotine reduces blood flow, which can lead to complications in the postoperative months.
Initial Postoperative Follow-Up
The first postoperative appointment is scheduled one month after the surgery. By this time, the patient will have already begun physical therapy. The swelling in the shoulder will have reduced, and the pain will have subsided. The scar, mobility, and new shoulder X-rays will be assessed by the surgeon, who may adjust the rehabilitation instructions for the coming months. Patients are typically allowed to drive again 45 days after the operation.
A second follow-up takes place four months after surgery. This visit ensures that rehabilitation has effectively restored the full range of shoulder motion and that the muscles are responsive. If the shoulder is in good condition, the surgeon may authorize a return to swimming, cycling, and running.
The third check-up is scheduled one year after the operation. At this stage, all pain should have disappeared, and shoulder mobility should be at its maximum.
Afterward, check-ups should be done every two years to verify the stability of the radiographic images and the absence of pain.
The results are generally very satisfactory, with a significant reduction in pain and a notable improvement in function. However, recovery depends on the patient’s commitment to rehabilitation and regular medical follow-up.
Risks and Benefits of Shoulder Replacement
Shoulder replacement offers:
- A notable improvement in mobility and functional abilities.
- A reduction in chronic pain, thereby improving daily comfort.
- A gradual return to regular and sometimes adapted sports activities.
Possible Complications and How to Prevent Them
Like any surgical procedure, shoulder replacement carries some risks, though rare:
- Infections: These can be prevented with good hygiene and close medical monitoring.
- Dislocation of the prosthesis: This can occur due to improper post-operative movements.
- Wear or loosening of the prosthesis: Regular monitoring helps track its evolution and anticipate any further interventions.
To minimize these risks, it is essential to follow your surgeon’s recommendations and adhere to a proper rehabilitation program, reporting any unusual pain promptly. In case of severe pain or infection, never attempt to self-medicate with antibiotics without the surgeon’s approval!
Shoulder replacement is an effective solution for patients suffering from severe joint pain, osteoarthritis, and loss of mobility. Thanks to medical advances and modern surgical techniques, results are increasingly optimized, allowing patients to regain a very satisfactory quality of life. For any questions or consultations, it is recommended to schedule an appointment with Dr. Bruno Lévy, orthopedic surgery specialist. An initial consultation will help determine the best therapeutic option.
