The shoulder is a “ball and socket” joint, with the ball-shaped head of the humerus (upper arm bone) fitting into a socket called the glenoid. The glenoid is smaller and is part of the shoulder blade (scapula). The rotator cuff is the collective name for the group of tendons and their associated muscles that surrounds the humeral head and helps with lifting and rotating the arm. The rotator cuff also helps to stabilize the shoulder and facilitate shoulder movement.
The ball is held in the socket by ligaments and by the rotator cuff tendons.
In a standard shoulder replacement surgery (also called anatomic total shoulder arthroplasty), a plastic cup replaces the worn cartilage surface of the shoulder socket (glenoid), and a metal ball is attached to the top of the humerus to replace the worn cartilage surface of the humeral head. The ball typically is attached to the humerus via a stem that is inserted down the shaft of the humerus. Another type of shoulder replacement surgery called a reverse total shoulder arthroplasty is used in special situations (severe fractures and massive, irreparable rotator cuff tears, for example) where a standard replacement would likely not work as well.
If Dr. Jurek determines that you are a candidate for shoulder replacement surgery, she will help you plan and prepare for your shoulder surgery. Please read Surgery Guidance before your surgery for information on what to expect before, during, and after your surgery and important tips and advice to make your recovery as easy and successful as possible.
Shoulder replacement surgery is major surgery requiring general anesthesia, so you can expect to need to take it very easy for the first couple of days after surgery. You will feel groggy and tired and this is normal as you recover from your shoulder replacement surgery. Depending on what type of work you do, you may be able to return to one-handed work or desk work within a week or two after surgery. If you do work that requires the use of your operative extremity and if that work is rigorous and physically demanding, you may need to be off of work or do modified light-duty work for 3 to 4 months following surgery. Dr. Jurek will work with you to determine an individualized plan that is safe and optimal for you to return to your desired work and recreational activities.
A combination of general anesthesia and regional anesthesia is used for shoulder replacement surgery. The regional anesthesia is called an “interscalene block” and it provides extended pain relief to help with the immediate postoperative pain after a shoulder replacement. The anesthesiologist may use a catheter (a small, flexible tube) connected to a pump to deliver numbing medication slowly over a couple of days as part of the block; you and your anesthesiologist will discuss the option of having a nerve catheter placed before you go to the operating room on the day of surgery.
Shoulder pain is different for each person who has a shoulder replacement but in general, you can expect to have pain for which you will take pain medication for 2 to 5 days after surgery. The purpose of the interscalene block is to minimize the amount of pain you feel after surgery and to therefore minimize the amount of narcotic pain medication you take in the first few days postoperatively.
See Things to Do Before Surgery for a list of strategies to help maximize your pain control after surgery.
Shoulder replacement surgery is performed in a hospital or at a surgery center, depending upon your medical history, health status, and insurance coverage (some insurances require shoulder replacement surgery to be performed in a hospital setting only, but this is changing). You can expect to stay overnight in the hospital and to be discharged the morning following your surgery. If you have your shoulder replacement performed at a surgery center, you will go home the same day.
After shoulder replacement surgery, Dr. Jurek will have you protect your shoulder in a sling for approximately 6 weeks. This time period allows the subscapularis tendon to heal which is very important in achieving a successful outcome.
Regularly scheduled physical therapy visits once or twice a week after a shoulder replacement are typically initiated 6 weeks post-op after anatomic total shoulder arthroplasty. Many patients benefit from a visit or two after their first postoperative visit with Dr. Jurek (usually 7-10 days after surgery) and before the 6-week pos-top mark to go over a few gentle exercises that are safe to perform during that time period.
Many Seattle physical therapists have full calendars and it is often beneficial to schedule your PT appointments well ahead of time (you can do this before your surgery to ensure your therapist’s availability after surgery).
After surgery, larger, loose-fitting shirts, especially shirts with a large neck opening and button-down shirts are helpful. See Things to Do Before Surgery for a list of helpful suggestions.
Sleep after shoulder surgery, particularly shoulder replacement surgery can be quite challenging. Many patients find sleeping more upright, propped up on pillows or a wedge pillow, or sleeping in a recliner to be very helpful. See Things to Do Before Surgery for a list of helpful suggestions.
Overall, the success rate for pain relief for shoulder replacement surgery is very good, and most patients report they are very satisfied with the results of their surgery.
Dr. Jurek will talk with you during your clinic visit about your personal goals for returning to sports and activities after shoulder replacement surgery. Many patients are able to return to high-level activities after a shoulder replacement surgery and she will answer any questions or specific concerns you may have regarding the activities and sports you wish to resume postoperatively.
Shoulder replacement surgery has a few specific risks associated with the procedure, as well as general risks inherent in any surgical procedure. These include: