Patient Education
Shoulder Replacement
Dr. Metzger specializes in shoulder replacements of all types. The following information may help you learn more about shoulder replacements. In addition, you may review his brochure for more information on the specific topic of the relatively new "Reversed" total shoulder replacements, with which he has extensive experience.
 
Why do a replacement?
Advanced arthritis can lead to the need for a replacement of the shoulder. So can loss of rotator cuff function as occurs with very large tears of the rotator cuff. Other times, people need replacements if they have had a severe fracture of the shoulder ball or socket, or if bone is missing from prior injury.

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Cat scan of a fractured bone Cat scan showing the bone-on-bone contact of advanced arthritis Missing bone from a gunshot wound, causing arthritis  
What exactly is a shoulder replacement?
There are 2 main types of replacements: Hemiarthroplasty, which is replacement of just the ball, and total shoulder replacement, which is replacement of both the ball and the socket. These are made of Chrome-Molybdenum and Titanium metal parts, and high density polyethylene plastic parts. Basically, the damaged bone is removed, and replaced by smooth metal and plastic pieces which are secured to the natural bone by a special orthopedic bone cement. Screws and press-fitting are also used to secure the pieces to the bone.
Hemiarthroplasty Total Shoulder Replacement Reversed Total Shoulder
   
What is the surgery like?

Surgery is done with complete anesthesia (you are all the way asleep), and sometimes with additional medicine near the nerves of the shoulder which greatly reduces pain after the surgery. It is an inpatient surgery, requiring between 1 and 3 nights in the hospital, with most people safely discharged home the day following the surgery.

 
   
Does it work?  
Experience with total shoulder replacement has been very good, with most patients reporting relief of most or all pain, and improving the ability to reach above head and behind-back.  
   
 
x-ray of replaced shoulder patient's arm movement 1 month after and 6 months after surgery  

Please note that this patient could not even move her arm away from her side before surgery.
She had had prior operations to try to repair the rotator cuff which were unsuccessful.

 
   
Is surgery safe?
Your surgeon will discuss the risks with you, but it is a very safe and effective procedure, with a low complication rate.
   
How about recovery?
Recovery occurs in stages, with the first stage being wound healing. It takes about 2-3 weeks. The next stage is recovery of motion, which takes 2-3 months. After than, recovery of strength takes about 3-4 more months, but there will be continued improvement for about 2 years after surgery. Most patients are able to do most things with the arm by about 2-3 weeks after surgery. Therapy is usually prescribed for 2-3 months after surgery.  
   

How long would I be out of my job or normal activites after surgery?
You will be sent home with a sling. We use several methods of post-operative pain relief that are very effective. You should move your wrist, hand, and fingers the day of surgery, as this helps prevent and reduce swelling and stiffness. The stitches are removed in the office in 1 week. Jobs with clerical or light-type of work can be resumed within 1-2 weeks. The time to return to work or activities really depends on the job or activity type more than anything.