You've Just Been Told You Need A Shoulder Replacement. Here Are Answers To Questions You Forgot To Ask.

If you've seen Dr. Jurek or another orthopaedic shoulder surgeon who has recommended that you consider undergoing shoulder replacement surgery, here are answers to some questions you may have:

A shoulder replacement is a surgery that replaces the surfaces of a worn out or injured shoulder joint with very smooth, strong metal and plastic surfaces to treat severe shoulder pain and improve function of the shoulder. 

Shoulder replacement surgery is considered an "open procedure" meaning that a small incision (usually measuring about 5 inches in length) is made and the surgery is performed through that incision. 

There is more than one different type of shoulder replacement; the most common are 1) anatomic total shoulder arthroplasty and 2) reverse total shoulder arthroplasty. 

Anatomic total shoulder arthroplasty replaces the ball of the shoulder joint (the humeral head) with a metallic ball and the socket/cup of the shoulder joint (the glenoid) with a socket. This is very comparable to a hip replacement surgery where the worn out part is removed and replaced with metallic component that essentially matches what was removed.

Reverse total shoulder arthroplasty is something entirely unique to the shoulder and switches up the anatomic relationships completely. Another term for this surgery is "inverse articulation surgery" but most people just refer to it as a "reverse." In reverse total shoulder replacement surgery, the ball of the shoulder joint (the humeral head) is replaced with a metallic socket component and the socket/cup of the shoulder joint (the glenoid) is replaced with a metallic ball (also called a "glenosphere"). There are special circumstances when a reverse total shoulder arthroplasty is a better option (and sometimes, the only viable option) as a replacement. This is something Dr. Jurek will discuss with you at length if shoulder replacement surgery is recommended to you.

There are many reasons why shoulder replacement surgery may be an excellent option for you.

One of the most common reasons why you need a shoulder replacement is that you have very severe arthritis of your shoulder and nonoperative treatment no longer adequately addresses your symptoms.

Many patients decide to have their shoulder replaced when they are having significant difficulties sleeping and/or doing their normal daily activities because of severe shoulder pain.

Other common reasons why shoulder replacement surgery is performed include: 1) treatment of certain shoulder fractures, 2) treatment of a shoulder with very large, irreparable rotator cuff tear (termed "cuff tear arthropathy") with severe shoulder pain and weakness, and 3) treatment of something called "avascular necrosis," which is when the blood supply to the shoulder fails and the bone dies as a result, causing severe shoulder pain.

A reverse total shoulder arthroplasty (reverse shoulder replacement) is a type of shoulder replacement that switches up the relationship of the shoulder joint, replacing the ball with a socket and a socket with a ball. This switch allows the shoulder to function very well without the need for a functional rotator cuff. It does this by harnessing the power of the deltoid muscle to become the motor of the shoulder.

The first reverse shoulder arthroplasty was performed in France in 1985 by Dr. Paul Grammont and the first reverse replacement was performed in the US in 2004. 

The short answer is: yes, you will be in a sling after shoulder replacement surgery. The longer answer is: the length of time you will be in a sling postoperatively depends on which type of shoulder replacement surgery you undergo. 

If you have anatomic total 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.

If you have reverse total shoulder replacement surgery, Dr. Jurek will have you protect your shoulder anywhere from about 10 days to 4 weeks after surgery. The reverse allows a slightly more aggressive postoperative recovery program in general as compared to an anatomic total shoulder replacement.

Physical therapy after a shoulder replacement is typically initiated 6 weeks postop after an anatomic total shoulder arthroplasty and anywhere from 10 days to 6 weeks postop after a reverse total shoulder arthroplasty. This is determined by Dr. Jurek on an individual basis for each of her patients depending on his or her specific circumstances.

Typically patients are off of work for 1 to 2 weeks following 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 of surgery. If you do work that requires the use of your operative extremity and if that work is rigorous and physically demanding, you may be off of work up to 3 to 4 months. Dr. Jurek will work with you one-on-one to determine an individualized plan that is safe and optimal for you.

The short answer to this question is: maybe.

The answer depends on a couple of factors:
1. Your particular health history and status. If you are very healthy and do not have any medical problems that would potentially require care in a hospital after surgery, you may be a good candidate for same day shoulder replacement surgery. On the other hand, if you have medical issues such as heart disease, diabetes, high blood pressure, or lung disease, it may be safest and best to perform your surgery in the hospital and have you stay overnight to ensure that you are safe to return home.
2. Your insurance. While this is slowly changing, many insurance companies will only cover a shoulder replacement surgery if it is performed in a hospital and the patient stays overnight. There are more and more insurance companies who recognize that certain patients do very well having their shoulder replacement surgery performed in a surgery center where they are able to go home the same day after their procedure. 
3. Your preference. Some patients feel very strongly about either staying in the hospital overnight or going home the same day as surgery. Dr. Jurek will talk with you about your preferences and together you will come up with a plan tailored specifically to you and your situation.

It is possible that your new shoulder will set off metal detectors at the airport but there is no need to worry. You can alert the TSA agent that you have a replacement and if your joint sets off the metal detector, the agent will simply pat you down and/or use a wand detector to confirm the presence of your shoulder replacement. The newer walk-through body scanners will show your shoulder replacement on the screen and an agent will likely pat you down to confirm that everything is in order. 

Once your shoulder is healed following shoulder replacement surgery, you will be able to do pretty much everything you want to do with your shoulder with a few important caveats. Especially initially, you may have some shoulder stiffness that will take time to resolve. It is possible that you may always have some limitations in range of motion following shoulder replacement surgery but usually these limitations do not compromise function or quality of life.

While Dr. Jurek does not put a discrete weight limit on how much you can lift after shoulder replacement surgery, you should not engage in heavy weight-lifting or repetitive high impact activities such as chopping wood following shoulder replacement surgery as this can cause loosening or failure of the implants. If you gradually build up the amount that you lift with your replaced shoulder, it is safe to lift heavy objects as long as you are able to safely control the load and protect your shoulder.