While hip replacements and knee replacements often dominate the conversation around joint health, shoulder replacements are quietly becoming more common. In 2022, 193,500 Americans chose to get shoulder replacement surgery, also called arthroplasty.
If your health care provider has said that you may be a candidate for shoulder replacement surgery, it helps to know what to expect before and during surgery, what you can do for the best recovery possible and what costs are involved.
[READ: The Complete Outpatient Surgery Checklist: Preparation and Recovery]
What Is Shoulder Replacement Surgery (Arthroplasty)?
Shoulder replacement surgery involves replacing all or part of your shoulder with an artificial shoulder. Specifically, it replaces the ball and socket joint, or the glenohumeral joint, of the shoulder.
“This is the joint responsible for your ability to move your arm and to rotate it in a circle, forward and back,” says Dr. Brian Lee, a board-certified orthopedic surgeon/elbow and shoulder specialist at Cedars-Sinai Orthopaedics in Los Angeles and an orthopedic consultant for the PGA Tour. “With muscles, tendons and cartilage surrounding the joint’s bone surfaces, the shoulder is a powerhouse of stability and mobility.”
It’s typically used when other types of treatments no longer help shoulder-related pain or your ability to use the shoulder is very limited.
A few common causes that may lead to shoulder replacement surgery include:
— Rotator cuff tears or disease. The rotator cuff is the muscles and tendons around the shoulder that assist it in moving and give it stability.
— Severe arthritis. “This is because severe arthritis damages the cartilage around the shoulder joint,” says Dhara Shah, a spokesperson for the American Physical Therapy Association and a board-certified clinical specialist in orthopedic physical therapy in Atlanta. “When cartilage is damaged or worn away, it’s bone-on-bone, limiting movement and causing pain and stiffness.”
— Shoulder fracture. Shoulder replacement surgery may be an option if plates, screws or other fixation devices used for a fracture can’t help.
— Osteonecrosis. This condition that disrupts blood supply to the bone. Osteonecrosis can destroy the shoulder joint and lead to arthritis.
[READ: Shoulder Impingement Syndrome Symptoms and Treatment]
Signs That You May Need Shoulder Replacement Surgery
Shoulder pain and stiffness are common signs that something could be wrong with your shoulder.
“In my practice, one of the most common reasons patients seek care is persistent pain at night,” says Dr. James M. Gregory, a shoulder and elbow surgeon and an associate professor in the Department of Orthopedic Surgery and associate program director for the Orthopedic Sports Medicine and Shoulder Fellowship at UT Health Houston. Other common signs include:
— Shoulder pain that disrupts sleep
— Difficulty lifting or raising the arm
— Loss of function with routine activities
If conservative treatments like oral medicines, physical therapy and injections aren’t helping, it may be time to consult a surgeon.
Types of Shoulder Surgery: Total, Partial and Reverse
There are a few types of shoulder replacement surgeries.
| Type of shoulder replacement surgery | Description |
| Full shoulder replacement | Replaces all of the joint surfaces with a metal ball and plastic socket. |
| Hemioarthroplasty, or partial shoulder replacement | Replaces only the head of the humerus (your upper arm’s long bone) with a ball. No plastic socket is used. |
| Reverse shoulder replacement | Moves the placement of the socket and metal ball, so the metal ball is attached to the shoulder bone and a plastic socket is attached to the humerus. |
“The best option depends on the patient’s anatomy and diagnosis, so that decision should be made in consultation with a shoulder surgeon,” Gregory says.
Preparing for Surgery: What to Expect Before and During
There are a few important steps that will take place before and during shoulder replacement surgery. Follow these steps as recommended by your surgeon and listen to any instructions from your surgical team and physical therapist to prepare for your surgery.
Before surgery
— You’ll meet with a surgeon who can do the procedure. This will likely be an orthopedic surgeon who specializes in the shoulder. Talk with your surgeons about expectations for the surgery and what to know about the recovery period.
— You may have a CT scan or MRI. These scans helps the surgeon better understand the anatomy for the surgical site and plan the surgery.
— You’ll meet with another health care provider. A primary care doctor can make sure you’re medically fit to proceed with surgery.
— You’ll discuss prehab, or working with a physical therapist before surgery. “Prehab can improve strength and mobility, range of motion and include patient education to ensure a smother post-operative experience,” Shah advises.
— Try on the sling ahead of time so you can get a sense of what it looks and feels like. “Think through how to do basic activities of daily living while following postoperative restrictions. A little preparation can make the early recovery period much smoother,” Gregory says.
— Speak with a professional about your home setup. A physical therapist or surgical team may be able to suggest any post-surgery home modifications so it’s easier to do daily tasks with your limited arm mobility during recovery.
[SEE: 11 Pre-Surgery Tips to Boost Recovery]
During surgery
Shoulder replacement surgeries nowadays are often performed at an ambulatory surgery center, or ASC. This is usually the case if you have enough support at home and you’re healthy enough. Surgery at an ASC is usually more streamlined and cost-effective. It also enables you to go home the same day.
Shoulder replacement surgery may take place at a hospital if you have more complex medical needs. You may still go home the same day of surgery, or you may stay overnight.
Here are some basics of the shoulder replacement itself as shared by Dr. Lee:
1. You’ll receive general anesthesia in an operating room. That means you’ll be asleep for the surgery. 2. The surgeon will make a small incision in the skin at the anterior shoulder. 3. Scar tissue is released, and damaged bone or tissue is removed and replaced with the material used for your artificial shoulder. This material will be sized for your specific shoulder joint.
The surgery itself takes under two hours to perform, and you’ll be in a recovery area for a few hours post-surgery to recover from the effects of anesthesia and to monitor for any possible complications.
Shoulder Replacement Recovery Timeline
Follow any steps recommended by your surgical team and physical therapist for a speedier recovery. Here’s what typically happens during recovery from shoulder replacement surgery:
First few days after shoulder replacement surgery
— Same day: You’ll be able to move around even though your shoulder will be protected. “After surgery, we encourage people to move. We don’t want you sitting in bed or convalescing because that can slow recovery,” says Dr. Gabriella E. Ode, an orthopedic surgeon at the Hospital for Special Surgery in New York City.
— First two to three days: Expect some discomfort, but you should expect significant improvement in pain with a few days. You’ll have pain-relief medications that you can use.
— For the first week: Have someone who can help you with dressing, bathing and other tasks. If you don’t have someone who can help, you may need to stay in a rehabilitation facility during your early recovery.
— Within a week: Expect to begin physical therapy. The exact timing may vary; Ode says it’s usually within a week after surgery for her patients. “Physical therapy is a key part of healing after shoulder replacement surgery,” Shah says. “It helps you restore your strength, get movement back and return to the activities you love.” Be consistent with your physical therapy appointments, even if progress seems slow. You may have to do physical therapy for about three to six months.
— Throughout the healing of the wound: Look out for signs of complications, like a fever over 101 F, worsening pain/redness or numbness. Get in touch with your surgeon right away if these symptoms occur.
Couple of weeks following shoulder surgery
— For two to six weeks: Expect to wear a sling, depending on the type of shoulder replacement that you have. You will need to limit how much you use your arm in the first couple of weeks. You may be advised not to lift anything heavier than a coffee cup in that same time period. However, that doesn’t mean you can’t move the arm at all. “We want to protect the joint at the shoulder, but we don’t often limit people’s ability to move their elbow, wrist or hand,” Ode says.
— In the weeks following surgery: Stay in touch with your surgeon, surgical team and physical therapist. “Recovery works best as a team effort,” Gregory says.
— For a few weeks following surgery: Expect some limitations on driving. Your surgical care team can let you know exactly how long to wait before you can drive.
A few months after surgery
— Around three months after surgery: Expect to be able to do many of your normal activities in a few months after surgery. However, your mobility can continue to improve for up to a year.
How Long Does a Shoulder Replacement Last?
Most shoulder replacements last 10 to 15 years, sometimes longer.
There are some things that can affect how long a shoulder replacement lasts, including:
— Age. Someone who’s older may move around less, and that would make the replacement last longer.
— Rotator cuff strength. The rotator cuff is the group of muscles and tendons that keep your shoulder stable.
— Physical activity level. More activity can wear out the replacement faster.
How Much Does Shoulder Replacement Surgery Cost?
Shoulder replacement surgery can range from $14,000 to $52,000, according to a 2018 analysis
in the Journal of Orthopedics.
That cost can vary so much based on the type of surgery performed, the surgical setting and what part of the country you live in.
Does Medicare cover shoulder replacement surgery?
Yes, Medicare covers shoulder replacement surgery if considered medically necessary.
If you have Medicare, you’ll still need to pay some of the costs toward your surgery. It’s a good idea to look closely at your Medicare plan before surgery so you know what costs are covered and which aren’t.
The Bottom Line: Is Shoulder Replacement Worth It?
Although surgery is always a daunting prospect, the results make shoulder replacement surgery worth it for many.
“Shoulder replacement can be a life-changing surgery for the right patient,” Gregory says. “Many people tell me they are able to return to activities they had not been able to do for years.”
Even if you want to recover quickly from shoulder replacement surgery, try to pace yourself. “It’s like training for a marathon,” Ode says. “You’re not going to be doing 26 miles on the first day. There’s a lot of retraining those muscles and regaining function and strength.”
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Shoulder Replacement Surgery: Signs, Types and Recovery Guide originally appeared on usnews.com
