Shoulder
Total Shoulder Replacement
A total shoulder replacement resurfaces an arthritic shoulder with an artificial ball and socket, arranged the same way the natural joint is. It depends on a working rotator cuff to keep the new ball centred in the socket, which is the difference from a reverse shoulder replacement, and it is what decides which of the two operations suits a given shoulder.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
When it is worth considering
This is the operation for shoulder arthritis in a shoulder whose rotator cuff is still doing its job. The pain is usually deep and aching rather than sharp, worse with use and eventually at rest, and movement, especially rotation, becomes progressively more limited and stiff.
It tends to be suitable when:
- Pain has stopped responding to physiotherapy, activity change and injections
- X-rays show joint space loss and bone spurring typical of arthritis
- The rotator cuff is intact or working well on examination and imaging
- Movement is limited enough to be affecting daily activity and sleep
Where the cuff is torn beyond repair, a standard replacement tends to fail, because there is nothing to hold the ball centred; a reverse shoulder replacement is the operation for that shoulder instead.
What the operation involves
Unlike the arthroscopic procedures elsewhere on this site, this is an open operation, done through an incision at the front of the shoulder, usually under general anaesthesia combined with a nerve block for pain relief afterwards. The arthritic head of the upper arm bone is replaced with a metal ball on a stem, and the socket is resurfaced with a plastic component.
It takes roughly ninety minutes to two hours. Hospital stay is typically two to three days, and the arm is protected in a sling for the first few weeks.
Shoulder replacement of both kinds was part of Dr. Khanna's shoulder fellowship at Seoul National University Bundang Hospital, South Korea.
What to expect afterwards
Pain relief is usually excellent and arrives early. Because the rotator cuff is intact and doing the work it is meant to, rotation and reaching overhead tend to recover more fully here than after a reverse replacement, where those movements are limited by design rather than by healing time.
That result depends on the cuff staying healthy. If it tears years later, which becomes more likely with age, a standard replacement can start to fail in the same way an untreated arthritic shoulder does, and revision surgery, sometimes to a reverse replacement, may be needed.
- Week 0 to 3. Sling, with gentle assisted movement as directed.
- Week 3 to 6. Out of the sling, active movement below shoulder height.
- Week 6 to 12. Movement overhead, light strengthening.
- Month 3 to 12. Steady improvement in strength and rotation.
Risks worth knowing about
Infection, nerve injury, dislocation and loosening of the components over time are the main general risks. The one that particularly separates this operation from a reverse replacement is the socket component wearing or loosening over the years, which is the classic long-term failure mode here, along with the rotator cuff itself tearing later and undermining the result.
Revision, if it is ever needed, is more involved than the original operation, though converting to a reverse replacement is a well-established procedure when the cuff turns out to be the problem.
Common questions
How is this different from a reverse shoulder replacement?
This operation keeps the joint's normal arrangement, ball on the arm bone and socket on the shoulder blade, and relies on the rotator cuff to hold it centred. A reverse replacement swaps that arrangement around so the deltoid muscle can lift the arm instead, which is used when the cuff cannot do the job. Which one suits you is decided by whether your rotator cuff is intact, not by preference.
Will I get full movement back?
Rotation and overhead reach generally recover well here, more fully than after a reverse replacement, because the muscles that produce those movements are still working. Some stiffness can remain, and how much depends on how stiff the shoulder was before surgery.
What happens if my rotator cuff tears years later?
It can undermine the replacement, in the same way an untreated cuff tear affects a natural shoulder. If that happens, the shoulder is reassessed, and revision to a reverse replacement is often the answer, since a reverse implant does not depend on the cuff at all.
How long does the implant last?
Commonly fifteen to twenty years or more in a well-selected shoulder with a healthy cuff, though the honest answer is that it depends heavily on whether the cuff continues to work well over that time, more than it does for a reverse replacement.
Not sure whether you need this?
That is the right question to bring to a consultation. Second opinions on surgery already advised elsewhere are a routine part of the practice. Bring your imaging and any plan you have been given.
Not sure this is your problem?
These start from the symptom rather than the operation, and cover what else can cause it and what gets tried first.